Utility of Extracellular Nicotinamide Phosphoribosyl Transferase as a Novel Biomarker - Predicting Early Severe Organ Dysfunction and Mortality in Acute Respiratory Distress Syndrome - A Prospective Observational Study

Q: What was the main objective of the study?

To determine whether extracellular NAMPT (eNAMPT) can predict early severe organ dysfunction and assess its association with mortality in acute respiratory distress syndrome (ARDS).

Q: How was eNAMPT evaluated in ARDS patients?

Plasma eNAMPT levels were measured and analyzed together with oxygenation, inflammatory markers, lung ultrasound scores, driving pressures, and echocardiography parameters.

Q: What eNAMPT thresholds were associated with outcomes?

An eNAMPT cut-off of ≥4.38 ng/mL predicted early severe organ dysfunction, and eNAMPT ≥4.175 ng/mL was associated with higher mortality and shorter median survival time.

Sep 30, 2026

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The study evaluates extracellular nicotinamide phosphoribosyl transferase (eNAMPT) as a biomarker for early severe organ dysfunction and mortality in acute respiratory distress syndrome (ARDS). In a single-center prospective observational cohort of 90 ARDS patients, plasma eNAMPT levels were measured alongside oxygenation, inflammatory markers, lung ultrasound scores, driving pressures, and echocardiography. Adjusted analyses identified eNAMPT as an early predictor of severe organ dysfunction and as associated with higher mortality and shorter median survival time.

LanguageEnglish

CategoryHealthcare

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Pages10

Reading Time25 min

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Background and aim

Patients and methods

Results

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ORIGINAL ARTICLE Utility of Extracellular Nicotinamide Phosphoribosyl Transferase as a Novel Biomarker in Predicting Early Severe Organ Dysfunction and Mortality in Acute Respiratory Distress Syndrome: A Prospective Observational Study Shwethapriya Rao1, Thejesh Srinivas2, Vishwas Parampalli3, Pratibha Todur4, Ashritha A Udupa5, Shruthi Rao6, Souvik Chaudhuri7 Visual Abstract Received on: 03 October 2025; Accepted on: 01 November 2025; Published on: 19 December 2025 AbstrAct Background and aim: Nicotinamide phosphoribosyl transferase (NAMPT) is an upstream cytozyme (cytokine plus enzyme) with unique features, having intracellular NAMPT (iNAMPT) and extracellular NAMPT (eNAMPT) components. Genetic associationsand therapeutic inhibition highlight its potential as both a biomarker and therapeutic target. We aimed to study the utility of eNAMPT as a predictor of severe organ dysfunction and its association with mortality in acute respiratory distress syndrome (ARDS) . Patients and methods: This is a single-center, prospective observational study involving 90 patients with ARDS. We noted plasma eNAMPT levels, oxygenation levels, inflammatory markers, lung ultrasound scores, driving pressures, and echocardiography parameters. Severity of organ dysfunction and ICU mortality were the outcomes. Results: Plasma eNAMPT was found to be a predictor of severe organ dysfunction in ARDS [adjusted OR: 1.343, 95% CI (1.105–1.634), p-value 0.003]. The cut-off eNAMPT level of ≥ 4.38 ng/mL was used to predict early severe organ dysfunction, with an AUCof 0.752, 95% CI (0.647–0.857), p-value < 0.001, sensitivity of 71.4%, and specificity of 79.2% . Plasma eNAMPT was significantly higher in non-survivors [4.53 (4–9.98) ng/mL] as compared to survivors [3.76 (3.40–4.29) ng/mL](p-value < 0.001). eNAMPT level ≥4.175 ng/mL was associated with higher mortality (hazard ratio: 3.82; 95% CI: 2.010–7.276, p-value < 0.001) and a shorter median survival time [5 days vs. 16 days (Log-rank (Mantel-Cox) p-value < 0.001] . Conclusion: Plasma eNAMPT (≥4.38 ng/mL) predicts early severe organ dysfunction in ARDS patients. It is also associated with mortality anda shorter median survival time. Keywords: Acute respiratory distress syndrome, severe organ dysfunction, Extracellular nicotinamide phosphoribosyl transferase, Visfatin, PreB-cell colony-enhancing factor, Sequential organ failure assessment. Indian Journal of Critical Care Medicine (2025): 10.5005/jp-journals-10071-25092 HigHligHts Plasma extracellular nicotinamide phosphoribosyl transferase (eNAMPT) is a reliable predictor of early onset severe organ dysfunction inARDS patients. The plasma eNAMPTwas significantly greater among non-survivors as compared to the survivors. High plasma eNAMPT levels were associated with marked hypoalbuminemia. introduction Despite therapeutic advances in care, acute respiratory distress syndrome (ARDS) is associated with severe organ dysfunction anda high mortality of up to 60% .1, 2 In fact, it is the severe organ dysfunction in ARDS that contributes to mortality, rather than the severity of hypoxemia.3 ARDS involves dysregulated inflammation across organs, alveolar capillary interface dysfunction, and oxidative stress.4 Thus, novel therapeutic strategies focusing on targeted specific molecular mediators of inflammation may improve outcomes.4 Nicotinamide phosphoribosyl transferase (NAMPT) has a few unique properties, which make it a topic of interest for research in ARDS.5–7 First, NAMPT is a cytozyme (cytokine plus enzyme), exhibiting a unique dual function determined by its cellular localization, whether 1–3,5–7Department of Critical Care Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India 4Department of Respiratory Therapy, Manipal College of Health Professions, Manipal, Karnataka, India Corresponding Author: Souvik Chaudhuri, Department of Critical Care Medicine, Kasturba Medical Co

FAQs

What was the main objective of the study?

To determine whether extracellular NAMPT (eNAMPT) can predict early severe organ dysfunction and assess its association with mortality in acute respiratory distress syndrome (ARDS).

How was eNAMPT evaluated in ARDS patients?

Plasma eNAMPT levels were measured and analyzed together with oxygenation, inflammatory markers, lung ultrasound scores, driving pressures, and echocardiography parameters.

What eNAMPT thresholds were associated with outcomes?

An eNAMPT cut-off of ≥4.38 ng/mL predicted early severe organ dysfunction, and eNAMPT ≥4.175 ng/mL was associated with higher mortality and shorter median survival time.

Sep 30, 2026

Upload by Putri