Prognostic value of pro-adrenomedullin and copeptin in acute infective endocarditis

BackgroundInfective endocarditis (IE) is a life-threatening disease whose prognosis is often difficult to predict based on clinical data. Biomarkers have been shown to favorably affect disease management in a number of cardiac disorders. Aims of this retrospective study were to assess the prognostic role of procalcitonin (PCT), pro-adrenomedullin (pro-ADM) and copeptin in IE and their relation with disease characteristics and the traditional biomarker C-reactive protein (CRP).MethodsWe studied 196 patients with definite IE. Clinical, laboratory and echocardiography parameters were analyzed, with a focus on co-morbidities. PCT, pro-ADM and copeptin were measured on stored plasma samples obtained on admission during the acute phase of the disease.ResultsPro-ADM and copeptin were significantly higher in older patients and associated with prior chronic kidney disease. Pro-ADM was an independent predictor of hospital mortality (OR 3.29 [95%C.I. 1.04-11.5]; p=0.042) whilst copeptin independently predicted 1-year mortality (OR 2.55 [95%C.I. 1.18-5.54]; p=0.017). A high PCT value was strictly tied with S. aureus etiology (p=0.001). CRP was the only biomarker associated with embolic events (p=0.003).ConclusionsDifferent biomarkers correlate with distinct IE outcomes. Pro-ADM and copeptin may signal a worse prognosis of IE on admission to the hospital and could be used to identify patients who need more aggressive treatment. CRP remains a low-cost marker of embolic risk. A high PCT value should suggest S. aureus etiology.

Automated summary

The levels of pro-ADM and copeptin in IE are associated with older age and prior chronic kidney disease. Pro-ADM can predict hospital mortality risk, copeptin can predict 1-year mortality risk, and a high PCT value is linked to Staphylococcus aureus etiology.