Hoge plasmaconcentratie van asymmetrisch dimethylarginine (ADMA) als onafhankelijke sterftevoorspeller bij intensivecarepatiënten

To determine in critically-ill patients the relation between indicators of renal and hepatic dysfunction and plasma-ADMA concentration, and the association between ADMA concentration and survival.

Design

Cross-sectional study.

Method

Blood samples were prospectively collected from a cross-section of critically-ill patients (n = 52) with clinical evidence of dysfunction of two or more organs. Correlates were identified for plasma-ADMA concentration with laboratory values, organ-failure scores and outcome using univariate and multiple regression analyses.

Results

In critically-ill patients, plasma-ADMA concentration was independently related to the presence of hepatic failure, and to lactic-acid and bilirubin concentration as markers of hepatic function. Twenty-one (40) patients died during their ICU stay. In a logistic regression model, plasma ADMA ranked as the first and strongest predictor for outcome, with a 17-fold increased risk for ICU death in patients who were in the highest quartile for ADMA level.

Conclusions

In critically-ill patients, plasma-ADMA concentration was a strong and independent risk factor for ICU mortality, and hepatic dysfunction was the most prominent determinant of ADMA concentration in this population.