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Mid-regional pro-adrenomedullin (MR-proADM) has a good biomarker profile: its half-life is several hours, and its plasma concentrations can be determined in clinical practice, it is essentially irrelevant, but proportionally represents the levels and activity of adrenomedullin (ADM). ADM synthesis is widely distributed in tissues, including bone, adrenal cortex, kidney, lung, blood vessels and heart. Its fundamental biological effects include vasodilator, positive inotropic, diuretic, natriuretic and bronchodilator.

It has been described high levels in septic patients, interacting directly with the relaxation of vascular tone, triggering hypotension of these patients. It is also found high levels in other diseases such as hypertension, heart failure, respiratory failure, renal failure, cirrhosis and cancer. MR-proADM has been identified as a prognostic marker, stratifying the mortality risk in patients with sepsis in emergency department (ED) and ICU. Evolutionary MR-proADM levels and clearance marker to the 2nd–5th days of admission help to determine the poor performance and the risk of mortality in patients with severe sepsis admitted to the ICU.

The MR-proADM levels are more effective than procalcitonin (PCT) and C-reactive protein (CRP) levels to determine an unfavorable outcome and the risk of mortality in patients with sepsis admitted to the ICU. It has also proved useful in patients diagnosed with organ dysfunction of infectious etiology.

MR-proADM levels are independent of the germ conversely it is related to the magnitude of organ failure and therefore severity. Berserk golden age arc 1 english dubbed. We consider advisable incorporating the MR-proADM the panel of biomarkers necessary for the diagnosis and treatment of critically ill patients admitted to the ICU with severe sepsis. The combined PCT and MR-proADM levels could represent a valid tool in the clinical practice to timely identify patients with bacterial infections and guide the diagnosis and treatment of sepsis and septic shock. Introduction Severity in septic patients is considered when perfusion disorders or organ dysfunction are present. Sepsis is becoming more and more common and, despite considerable efforts to treat it, continues to have a high mortality rate (,). In these patients it is essential to initiate early support measures and specific treatments, perhaps being the most effective the early administration of antibiotics. A clear relationship has been shown between the time antibiotics are started and prognosis (,).

It is also necessary early monitoring measures and support, so they should be admitted to the ICU, and thus improve prognosis (-). The profile of a good biomarker is a molecule measurable objectively, systematically and in a precise form, identifying normal and pathological levels and being able to monitor the response to the treatment. Its properties should be: establish an early diagnosis, quantify the risk (severity, mortality) and monitor the evolution of the infection and the response to the treatment (). A multitude of biomarkers have been studied, but no solution to this problem has been found. Of all those described, the C-reactive protein (CRP) and procalcitonin (PCT) are the most often used (,). Other markers, less specific, related to systemic response, organ failure (fibrinogen, antithrombin, D-dimer, lactate, N-terminal pro-B-type natriuretic peptide) or immune dysfunction (HLA-DR, ferritin) have also been shown to be useful (). Mid-regional pro-adrenomedullin (MR-proADM) has recently been incorporated as a biomarker.

Adrenomedullin (ADM) and MR-proADM ADM is a peptide hormone of 52 amino acids that was isolated in 1993 from extracts of a human pheochromocytoma (). The sequences of a messenger RNA (mRNA) and the ADM gene associated have been identified in several mammalian species.

The ADM belongs to the calcitonin gene peptide superfamily: calcitonin, PCT, the calcitonin gene-related peptide (CGRP), amylin and ADM. ADM molecule has a 27% similarity to CGRP (-). The gene for human ADM, located to a single locus on chromosome 11 consists in 4 exons and 3 introns. The mRNA encodes the information for synthesis of a preprohormone known as preproadrenomedullin, of 185-amino acids, subsequently degraded into 164-amino acids peptide called proadrenomedullin by cleaving the signal peptide. The proadrenomedullin has three vasoactive peptides, the ADM, the aminoterminal peptide of proadrenomedullin (PAMP) and adrenotensin.