Disclosures: Azadeh Shafieesabet, MD: No financial relationships or conflicts of interest

Objective: An early and reliable prediction of outcomes after stroke is important for early effective stroke management and the adequate optimal planning of post-stroke rehabilitation and long-term care. The aim of this study was to investigate the prognostic value of bio-ADM on outcomes after rehabilitation in patients with stroke.

Design: Prospective observational study

Setting: Admitted to an in-patient early rehabilitation center directly after discharge from acute stroke hospital care

Participants: 557 consecutive patients with a primary diagnosis of ischemic or hemorrhagic stroke

Interventions: Plasma concentrations of bio-ADM were determined by using a chemiluminescence immunoassay (functional assay sensitivity 8 pg/mL).

Main Outcome Measures: The Early Rehabilitation Barthel Index (ERBI) was used for the neurological assessment of the patients. The plasma bio-ADM level was analyzed in association with six-month all-cause mortality as well as a composite outcome of all-cause mortality, unscheduled re-hospitalization, or transfer to a long-term care facility in a vegetative or minimally conscious state.

Results: Bio-ADM levels significantly increased in patients with ischemic stroke who died compared to surviving patients (40.4 pg/mL vs. 23.8 pg/mL, p < 0.0001) or in those with composite outcomes compared to those with no events (36.9 pg/ml vs. 23.5 pg/mL, p < 0.0001). Six-month all-cause mortality was higher in all patients with bio-ADM levels >70 pg/mL (HR: 4.83 [CI 2.28–10.2]). Patients with bio-ADM levels >70 pg/mL also had higher rates of six-month composite outcomes (HR: 3.82 [CI 2.08–7.01]). Bio-ADM was an independent predictor of all-cause mortality and six-month composite outcomes after adjusting for age, gender, and ERBI (adjusted OR: 1.5; 95% CI, 1.0–2.1; p = 0.047 and adjusted OR: 1.79; 95% CI, 1.2–2.6; p = 0.004, respectively).

Conclusions: Bio-ADM may be a suitable novel biomarker to assess the outcomes of patients in rehabilitation after acute stroke. Elevated bio-ADM concentrations may have prognostic value for fatal and nonfatal events in patients with ischemic stroke during early rehabilitation.

Level of Evidence: Level II

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/plasma-bioactive-adrenomedullin-predicts-outcome-after-acute-stroke-and-early-rehabilitation/