Clinical value of pre-discharge bio-adrenomedullin as a marker of residual congestion and high risk of heart failure hospital readmission

Paloma Pandhi, Jozine M Ter Maaten, Johanna E Emmens, Joachim Struck, Andreas Bergmann, John G Cleland, Michael M Givertz, Marco Metra, Christopher M O'Connor, John R Teerlink, Piotr Ponikowski, Gad Cotter, Beth Davison, Dirk J van Veldhuisen, Adriaan A Voors*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Aims Recently, bio-adrenomedullin (bio-ADM) was proposed as a congestion marker in heart failure (HF). In the present study, we aimed to study whether bio-ADM levels at discharge from a hospital admission for worsening HF could provide additional information on (residual) congestion status, diuretic dose titration and clinical outcomes. Methods and results Plasma bio-ADM was measured in 1236 acute HF patients in the PROTECT trial at day 7 or discharge. Median discharge bio-ADM was 33.7 [21.5-61.5] pg/mL. Patients with higher discharge bio-ADM levels were hospitalised longer, had higher brain natriuretic peptide levels, and poorer diuretic response (all P <0.001). Bio-ADM was the strongest predictor of discharge residual congestion (clinical congestion score > 3) (odds ratio 4.35, 95% confidence interval 3.37-5.62; P <0.001). Oedema at discharge was one of the strongest predictors of discharge bio-ADM (beta = 0.218; P <0.001). Higher discharge loop diuretic doses were associated with a poorer diuretic response during hospitalisation (beta = 0.187; P <0.001) and higher bio-ADM levels (beta = 0.084; P = 0.020). High discharge bio-ADM levels combined with higher use of loop diuretics were independently associated with a greater risk of 60-day HF rehospitalisation (hazard ratio 4.02, 95% confidence interval 2.23-7.26; P <0.001). Conclusion In hospitalised HF patients, elevated pre-discharge bio-ADM levels were associated with higher discharge loop diuretic doses and reflected residual congestion. Patients with combined higher bio-ADM levels and higher loop diuretic use at discharge had an increased risk of rehospitalisation. Assessment of discharge bio-ADM levels may be a readily applicable marker to identify patients with residual congestion at higher risk of early hospital readmission.

Original languageEnglish
Number of pages9
JournalEuropean Journal of Heart Failure
Publication statusPublished - 3-Dec-2019


  • Bio-adrenomedullin
  • Loop diuretics
  • Acute heart failure

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