ADMA and the outcome during intensive care unit treatment

In a prospective clinical trial investigators from the Netherlands were able to demonstrate that ADMA is a powerful predictor for the survival of patients during treatment in a multidisciplinary intensive care unit: 52 patients were included in this study who were being treated in the ICU unit for failure of at least two organ systems. ADMA levels were measured, as well as numerous other biomarkers for organ fuction. ADMA was the most powerful predictor of ICU unit survival in multivariate analysis [67]. ADMA levels were significantly higher at the beginning of the study in those patients who died during ICU treatment than in those who survived. Patients with ADMA levels in the highest quartile had a 17-fold elevated relative risk of not surviving ICU treatment. A large portion of the patients included in this study were patients who had experienced a complication during surgical intervention, i.e. with no explicit preexisting cardiovascular disease. The same authors were able to show that circulating ADMA concentration is controlled in large part by renal and hepatic function [67, 68]. This finding is of particular importance, as dimethylarginine dimethylaminohydrolase (DDAH), the enzyme that inactivates ADMA, is highly expressed in liver and kidney. Therefore, this enzyme may play an important role in the regulation of ADMA levels in several disease states. An elevation of ADMA concentration in patients with end-stage liver failure was also found by other investigators [69].