Adrenomedullin to guide therapy of blood pressure decline

Abstract

Subject matter of the present invention is an in vitro method for identifying a subject in need of administration of fluid resuscitation or a vasopressor comprising the following steps: Determining the level of proADM and/or fragments thereof having at least 6 amino acids in a bodily fluid of said subject Correlating said level with the need of said patient for fluid resuscitation or administration of a vasopressor wherein said patient is identified as having such a need if the level of proADM and/or fragments thereof having at least 6 amino acids in the bodily fluid of said subject is above a threshold.

1 - 20 . (canceled) 
     
     
         21 . A composition comprising:
 a complex comprising at least one binder to proADM (SEQ ID No. 1) and/or fragments and at least one binder to MR-proADM and/or fragments thereof,   sample of bodily fluid obtained from a subject who is not suffering from a physiological shock state,   wherein the complex contains more than 70 pg/ml of proADM (SEQ ID No. 1) and/or fragments, and/or its isoforms and more than 0.7 nmol/L of plasma MR-proADM and/or fragments thereof within said composition.   
     
     
         22 . The composition of  claim 21 , wherein said proADM (SEQ ID No. 1) and/or fragments thereof having at least 6 amino acids are selected from the group comprising mature ADM (SEQ ID No. 4) and/or mature ADM 1-52-Gly (SEQ ID No. 5) and MR-proADM (SEQ ID No.3) and CT-ADM (SEQ ID No. 6). 
     
     
         23 . The composition of  claim 22  wherein either a level of mature ADM (SEQ ID No. 4) immunoreactivity and/or a level of mature ADM 1-52-Gly (SEQ ID No. 5)—immunoreactivity or a level of MR-proADM (SEQ ID No.3) immunoreactivity or a level of CT-ADM (SEQ ID No.6) immunoreactivity is above a threshold. 
     
     
         24 . The composition of  claim 21 , wherein the level of pro-ADM (SEQ ID No. 1) and/or fragments thereof is measured by using at least one binder selected from the group consisting of a binder that binds to a region comprised within the following sequence of mature ADM (SEQ ID No. 4) and/or mature ADM 1-52-Gly (SEQ ID No. 5) and a second binder that binds to a region comprised within the following sequence of mature ADM (SEQ ID No. 4) and/or mature ADM 1-52-Gly (SEQ ID No. 5). 
     
     
         25 . The composition of  claim 21 , wherein the level of pro-ADM (SEQ ID No. 1) and/or fragments thereof is measured by using at least one binder selected from the group consisting of a binder that binds to a region comprised within the following sequence of MR-proADM (SEQ ID No. 3) and a second binder that binds to a region comprised within the following sequence of MR-proADM (SEQ ID No. 3) 
     
     
         26 . The composition of  claim 21 , wherein the level of pro-ADM (SEQ ID No. 1) and/or fragments thereof is measured by using at least one binder selected from the group consisting of a binder that binds to a region comprised within the following sequence of CT-proADM (SEQ ID No. 6) and a second binder that binds to a region comprised within the following sequence of CT-proADM (SEQ ID No. 6). 
     
     
         27 . The composition of  claim 21 , wherein an assay is used for measuring the level of proADM (SEQ ID No.1) and/or fragments thereof having at least 6 amino acids wherein the assay sensitivity of said assay is able to quantify the ADM of healthy subjects and is <70 pg/ml. 
     
     
         28 . The composition of  claim 21 , wherein said binders exhibits a binding affinity to proADM (SEQ ID No. 1) and/or fragments thereof of at least 10 7  M −1 . 
     
     
         29 . The composition of  claim 21 , wherein said binders are selected from the group consisting of an antibody or an antibody fragment and a non-Ig scaffold binding to proADM (SEQ ID No. 1) and/or fragments thereof. 
     
     
         30 . The composition of  claim 27 , wherein said assay is a sandwich assay. 
     
     
         31 . The composition of  claim 21 , wherein said binders are labeled in order to be detected. 
     
     
         32 . The composition of  claim 21 , wherein at least one of said binders is bound to a solid phase. 
     
     
         33 . The composition of  claim 21 , wherein said sample of bodily fluid is selected from the group consisting of human citrate plasma, heparin plasma, EDTA plasma, whole blood, and serum.