BACKGROUND: To evaluate if plasma levels of midregional pro-adrenomedullin 
(MR-proADM) improve prediction of functional outcome in ischemic stroke.
METHODS: In 168 consecutive ischemic stroke patients, plasma levels of MR-proADM 
were measured within 24 hours from symptom onset. Functional outcome was 
assessed by the modified Rankin Scale (mRS) at 90 days following stroke. 
Logistic regression, receiver operating characteristics (ROC) curve analysis, 
net reclassification improvement (NRI), and Kaplan-Meier survival analysis were 
applied.
RESULTS: Plasma MR-proADM levels were found significantly higher in patients 
with unfavourable (mRS 3-6) compared to favourable (mRS 0-2) outcomes. MR-proADM 
levels were entered into a predictive model including the patients' age, 
National Institutes of Health Stroke Scale (NIHSS), and the use of 
recanalization therapy. The area under the ROC curve did not increase 
significantly. However, category-free NRI of 0.577 (p<0.001) indicated a 
significant improvement in reclassification of patients. Furthermore, MR-proADM 
levels significantly improved reclassification of patients in the prediction of 
outcome by the Stroke Prognostication using Age and NIHSS-100 (SPAN-100; 
NRI = 0.175; p = 0.04). Kaplan-Meier survival analysis showed a rising risk of 
death with increasing MR-proADM quintiles.
CONCLUSIONS: Plasma MR-proADM levels improve prediction of functional outcome in 
ischemic stroke when added to the patients' age, NIHSS on admission, and the use 
of recanalization therapy. Levels of MR-proADM in peripheral blood improve 
reclassification of patients when the SPAN-100 is used to predict the patients' 
functional outcome.