Endothelial function biomarker bio-ADM®

In critical care settings, one of the main causes of organ failure and ultimately mortality is loss of endothelial function, which is associated with leakage of blood vessels. Although the symptoms of loss of endothelial functions are well-known, there are currently no simple, blood-based detection methods established for monitoring the worsening and improvement of endothelial function.
bio-ADM® can easily be measured in the blood enabling the assessment of the endothelial function up to 48 hours before the symptoms become visible. Regular assessment of the bio-ADM® levels allows for the monitoring of critically ill patients.

Elevated bio-ADM® blood levels predict both blood pressure drop resulting in shock as well as leaky vessels leading to the formation of edema (1a). Decreasing levels of bio-ADM® reflect an improvement of the endothelial function, which is closely associated with the patient’s clinical condition(1b).


  • is a blood-based parameter for quantifying the levels of bioactive Adrenomedullin
  • aids in the early prediction of shock and vasopressor demand in critically ill patients
  • allows monitoring of the endothelial function
  • is independent from inflammation or any other comorbidities
  • aids in the diagnosis of residual congestion
  • has been validated in more than 22,000 patients

The relevance of endothelial function in critical care

Healthy state

Research has identified bioactive Adrenomedullin as a controlling hormone of the endothelial barrier, the interior wall protecting the blood vessels (2a). The median bio-ADM® concentration of 200 healthy subjects was 20.7 pg/mL; the 99th percentile was 43 pg/mL.



Disease state

In certain conditions such as septic shock, cardiogenic shock or acute heart failure, the endothelial barrier becomes leaky, and additional bio-ADM® is produced to re-seal the barrier. However, bio-ADM® has a second function. It also expands the blood vessels, resulting in a dangerous blood pressure drop, which leads to shock and may ultimately escalate into multiple organ failure (2b).



The assay for the endothelial function biomarker bioactive Adrenomedullin

IB10 sphingotest® bio-ADM® is a rapid point-of-care (POC) immunoassay for the quantitative in vitro determination of bioactive Adrenomedullin (bio-ADM®) in human EDTA whole blood or plasma.

Nexus IB10


1. Arfsten et al. (2020), Increased concentrations of bioactive adrenomedullin subsequently to ARNi treatment in chronic systolic heart failure Read more
2. Blet et al (2020), Added value of serial bio-adrenomedullin measurement in addition to lactate for the prognosis of septic patients admitted to ICU Read more
3. Goetze et al (2020), Bioactive adrenomedullin in plasma is associated to biventricular filling pressures in patients with advanced heart failure, Read more
4. Gombert et al (2020), Postoperatively increased bioactive adrenomedullin is related to adverse outcome after complex aortic surgery, Read more
5. Liu et al (2020), The value of plasma pro-enkephalin and adrenomedullin for the prediction of sepsis-associated acute kidney injury in critically ill patients, Read more
6. Arrigo et al (2019), Plasma bio-adrenomedullin is a marker of acute heart failure severity in patients with acute coronary syndrome, Read more
7. Kim et al (2019), Circulating biologically active adrenomedullin predicts organ failure and mortality in sepsis, Read more
8. Lemasle et al (2019), Bioactive adrenomedullin, organ support therapies, and survival in the critically ill: Results from the French and European Outcome Registry in ICU study, Read more
9. Molvin et al (2019), Bioactive adrenomedullin, proenkephalin A and clinical outcomes in an acute heart failure setting, Read more
10. Pandhi et al (2019), Clinical value of pre-discharge bio-adrenomedullin as a marker of residual congestion and high risk of heart failure hospital readmission, Read more
11. Staszewsky et al (2019), Adrenomedullin, a circulating biomarker of congestion: in search of evidence, Read more
12. ter Maaten et al (2019), Bio-adrenomedullin as a marker of congestion in patients with new-onset and worsening heart failure, Read more
13. Gayat et al (2018), Determinants of long-term outcome in ICU survivors: results from the FROG-ICU study, Read more
14. Geven et al (2018), Adrenomedullin and adrenomedullin-targeted therapy as treatment strategies relevant for sepsis, Read more
15. Kremer et al (2018), Bio-adrenomedullin as a potential quick, reliable, and objective marker of congestion in heart failure, Read more
16. Mebazaa et al (2018), Circulating adrenomedullin estimates survival and reversibility of organ failure in sepsis: the prospective observational multinational Adrenomedullin and Outcome in Sepsis and Septic Shock-1 (AdrenOSS-1) study, Read more
17. Voors et al (2018), Adrenomedullin in heart failure: pathophysiology and therapeutic application, Read more
18. Caironi et al (2017), Circulating biologically active adrenomedullin (bio-ADM) predicts hemodynamic support requirement and mortality during sepsis, Read more
19. Tolppanen et al (2017), Adrenomedullin: a marker of impaired hemodynamics, organ dysfunction, and poor prognosis in cardiogenic shock, Read more
20. Weber et al (2017), Sandwich immunoassay for bioactive plasma adrenomedullin, Read more
21. Yuyun et al (2017), Prognostic value of human mature adrenomedullin in patients with acute myocardial infarction, Read more
22. Self et al (2016), Plasma bioactive adrenomedullin as a prognostic biomarker in acute heart failure, Read more
23. Simon et al (2016), Plasma adrenomedullin in critically ill patients with sepsis after major surgery: a pilot study, Read more
24. Marino et al (2014), Plasma adrenomedullin is associated with short-term mortality and vasopressor requirement in patients admitted with sepsis, Read more