Could this be the cure for one of the leading causes of death?
Sepsis is a life-threatening compilation to an infection that tends to happen post-surgery.
Sepsis can cause organ damage and death. This condition leads to more deaths in the UK than breast and prostate cancer combined. If we can find out if a patient has sepsis and how severe it is, serious consequences can be avoided.
Adrenomedullin (ADM) is a substance found in blood tests. Studies have found that ADM can be used to a patient with sepsis and also find out how serious it is.
Vasopressor is drug used to increase blood pressure. This is useful in patients with severe sepsis because their blood pressure tends to fall.
If we know when to use vasopressor we can raise the blood pressure before it gets too low. This means patients will be less likely to suffer from further problems that sepsis can lead to.
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By doing this, fewer patient who have sepsis will die. Testing ADM levels in patients who are thought to have sepsis just after surgery can help to make better decisions.
A pilot study was used for this research. This is a small-scale practice test used to design the larger research study. This meant a small number of people took part in the trial.
Only 42 patients who had developed sepsis were used in the trial. Researchers will need to carry out tests on more people to see if ADM levels can be used as diagnostic treatment for sepsis.
For further information on sepsis visit the following link:
https://www.nhs.uk/conditions/sepsis
Originality and Scientific rigour
Methodology
The research automatically assumed that all the non-survivors in the 90-day mortality statistics had died from sepsis. There would have been other factors that lead to their death and the research did not consider this. The median age of the patients was 70. The chances of them suffering from other health related issues is higher.
In figure 2, the control group were included in the ‘survivor’ category. However, the control group were not suspected of having sepsis. Therefore, they are more likely to survive in the 90 day as they did not show signs of the condition. Therefore, this will decrease the IQR and P-value. If they did not develop sepsis, they shouldn’t have been included in the ‘survivor’ category. By doing this, the P-value and IQR would have decreased so much that the results would have been clinically insignificant. However, we can only assume this until we can obtain the primary data.
Interpreting results
In figure 2, the higher extremity of the survivor category is higher than in the non-survivor category. This shows that some people who survived had a higher ADM level than those who didn’t. This goes against the findings of the study. Because only 42 participants were used, higher standard deviations are more likely to occur. This makes it hard to make clear judgements from this information.
Originality
There is a 1996 and 2010 research paper that have both found a correlation between ADM levels and sepsis. (1,2) The 2010 paper found a link between increased ADM levels and having severe sepsis. Therefore, it isn’t a unique idea to study the correlation between ADM levels and how severe sepsis is.
Weaknesses
Only one blood test from each patient was used. To obtain more tests should be done to obtain (reliable) results that show a strong correlation between ADM levels and vasopressor use or ADM levels and mortality at 28 and 90 days.
Significance
The purpose of this study is to find ways of providing more effective patient care for sepsis sufferers. This condition is a major cause of death. Therefore, we need to find new ways to improve care globally.
Since the control group were included in the ‘survivor’ category in figure 2, insignificant results were produced. This provides weak evidence on the relationship between ADM levels and severity of sepsis. A small number of participants would make it difficult to reach a judgement from figures 2 and 3, reducing the importance of the research paper. More participants would need to be included to draw conclusions about the correlation between ADM levels and 90-day mortality, and the requirement to use vasopressor.
Major surgery was the dependent variable within the group that were suspected of sepsis. However, it doesn’t define what exactly a ‘major surgery’ is. This could possibly make reproducing data difficult.
The relationship between the sepsis severity and ADM levels is evidence that is clearly shown in the study. Other papers which have referenced the study. This shows that the study can easily be reproduced. As of 21/11/18, this paper has been referenced six times. such as by Taizhou Hospital in China, to show evidence that there is a correlation between how ADM levels and sepsis severity. However, it wasn’t used as new knowledge.
The 2014 study found a strong association of ADM levels to severity of sepsis (cited 32 times). (3) It used 101 patients where multiple blood tests were taken from each patient. This would more produce reliable data. When conducting a larger study, the paper could use this to find stronger evidence.
Although this paper has many weaknesses, it is a pilot study and the paper has considered many limitations of this study. As they have found strong correlations between ADM and sepsis severity, and have a clear methodology, they can repeat this as a large multicentre study. This parameter could allow faster diagnosis and lower death rates.References
1 Y Hirata, C Mitaka, K Sato, T Nagura, Y Tsunoda, K Amaha, F Marumo. Increased circulating adrenomedullin, a novel vasodilatory peptide, in sepsis. JCEM. 1996; 81(4):1449-1453 doi: https://doi.org/10.1210/jcem.81.4.86363492 R Wang, F Kang. Prediction about severity and outcome of sepsis by pro-arterial natriuretic peptide and pro-adrenomedullin. ScienceDirect. 2010; 13(3):152-157 doi: https://doi.org/10.3760/cma.j.issn.1008-1275.2010.03.0043 R Marino, J Struck, A Maisel, L Magrini, A Bergmann, S Somma. Plasma adrenomedullin is associated with short-term mortality and vasopressor requirement in patients admitted with sepsis. Critical Care. 2014; 18(R34):1-7 doi: https://doi.org/10.1186/cc13731
