University Hospital Essen

Necrotizing fasciitis (NF) is a rapidly progressing condition with a high mortality rate. The poor prognosis is often due to delayed diagnosis, which is typically made clinically or radiologically. This case report highlights a rare instance of fulminant NF with an atypical presentation—no initial clinical signs and an unusual radiological appearance. Both the localization and microbiological findings (non-resistant Klebsiella pneumoniae) were uncommon for NF. The patient presented with no suspicious skin changes, pain, or medical history indicative of NF. A computed tomography scan revealed entrapped air, a pathognomonic sign of NF; however, the air was predominantly located in the abdomen, leading to an initial suspicion of hollow organ perforation because this is an unusual location for NF. Subsequently, NF was suspected based on the computed tomography findings combined with laboratory results. Despite prompt surgical intervention and broad-spectrum antibiotic therapy, the patient died of multi-organ failure within 16 hours. This case underscores the importance of recognizing the subtle and varied presentations of NF and using tools such as the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score. Healthcare providers must maintain a high index of suspicion for NF, even when clinical, radiological, and laboratory findings seem inconspicuous.

We investigated the effect of center-specific variables on overall survival (OS) after allogeneic hematopoietic cell transplantation (alloHCT) in acute myeloid leukemia (AML). Eligible were adult patients reported to DRST registry receiving first alloHCT for AML from a related or matched (>= 9/10 HLA-match) unrelated donor 2015-2021. Primary endpoint was OS at 12 months from alloHCT. Univariable and multivariable analyses after best subset selection was performed. Of 5328 patients, 83% received alloHCT in a high-volume center (≥40 alloHCT/year); 90% in a university hospital; 90% in a center performing alloHCT for ≥10 years; and 73% in a Joint Accreditation Committee IHCT-Europe and EBMT (JACIE) accredited center. 52% of the patients were in CR1, and ELN risk was adverse in 37% and intermediate in 42%. On multivariable analysis, center-specific factors predicting adverse 12-month OS were program duration

Background Whole lung transpulmonary chemoembolization using a combination of doxorubicin (DXO) and degradable starch microspheres (DSM-TPCE) might be a promising treatment option in soft tissue sarcoma. To pave the way for clinical studies, this study aimed to evaluate the short-term effects of DSM-TPCE with DXO using an ex vivo isolated lung perfusion (ILP) model. Methods Nine lung specimens retrieved from patients undergoing lobectomy underwent ex vivo ILP. In groups of three, lung specimens were either treated with sole DXO, sole DSM, or combined substances (DSM + DXO). During ex vivo ILP, histological samples were obtained from each lung every 15 min. Quantitative DXO analysis and histopathological grading of possible tissue damage using a five-point Likert scale was performed. Two-way repeated measures ANOVA tested for differences between treatment groups and changes over time. Results We created a preclinical ex vivo ILP model to simulate the effects of DSM-TPCE. In histopathological analysis, only two specimens, treated with only DXO, showed an increase in parenchymal damage over time. No significant effect of time (3.3%, p = 0.305) or group (23.3; p = 0.331) was identified. Within the lung tissue, the DXO concentration ranged from 205 to 1,244 ng/g. No significant effects could be detected regarding different treatment groups (4.9% of total variation, p = 0.103). Conclusion In an ex vivo ILP model using human lung lobes, the physiological effects of DSM-TPCE with DXO could be tested. Neither increased DXO concentrations in lung tissue nor histopathological changes indicating early lung toxicity were observed. Relevance statement An ex vivo ILP model using human lung specimens did not show any signs of early lung toxicity after transpulmonary chemoembolization with DXO. These results support further evaluation of DSM-TPCE in phase I/II trials. Key Points Transpulmonary chemoembolization can be investigated in an ex vivo ILP model. DSM did not increase DXO in normal lung tissue. DSM did not increase parenchymal toxicity compared to the control groups. Graphical Abstract

Background Non-malignant chronic diseases remain a major public health concern. Given the alterations in lipid metabolism and deposition in the lung and its association with fibrotic interstitial lung disease (fILD) and chronic obstructive pulmonary disease (COPD), this study aimed to detect those alterations using computed tomography (CT)-based analysis of pulmonary fat attenuation volume (CTpfav). Methods This observational retrospective single-center study involved 716 chest CT scans from three subcohorts: control ( n = 279), COPD ( n = 283), and fILD ( n = 154). Fully automated quantification of CTpfav based on lung segmentation and HU-thresholding. The pulmonary fat index (PFI) was derived by normalizing CTpfav to the CT lung volume. Statistical analyses were conducted using Kruskal–Wallis with Dunn’s post hoc tests. Results Patients with fILDs demonstrated a significant increase in CTpfav (median 71.0 mL, interquartile range [IQR] 59.7 mL, p < 0.001) and PFI (median 1.9%, IQR 2.4%, p < 0.001) when compared to the control group (CTpfav median 43.6 mL, IQR 16.94 mL; PFI median 0.9%, IQR 0.5%). In contrast, individuals with COPD exhibited significantly reduced CTpfav (median 36.2 mL, IQR 11.4 mL, p < 0.001) and PFI (median 0.5%, IQR 0.2%, p < 0.001). Conclusion The study underscores the potential of CTpfav and PFI as imaging biomarkers for detecting changes in lung lipid metabolism and deposition and demonstrates a possibility of tracking these alterations in patients with COPD and ILDs. Further research is needed to validate these findings and explore the clinical relevance of CTpfav and PFI in lung disease management. Relevance statement This study introduces a fully automated method for quantifying CTpfav, potentially establishing it as a new imaging biomarker for chronic lung diseases. Key Points This retrospective observational study employed an open-source, automated algorithm for the quantification of CT pulmonary fat attenuation volume (CTpfav). Patients with fibrotic interstitial lung disease (fILD) showed a significantly higher CTpfav and pulmonary fat index (PFI), i.e ., CTpfav/CT lung volume, compared to a control group. Patients with chronic obstructive pulmonary disease (COPD) showed significantly lower CTpfav and PFI compared to the control group. CTpfav and PFI may each serve as imaging biomarkers for various lung diseases and warrant further investigation. Graphical Abstract

Zusammenfassung Einleitung Kongenitale Dakryozystozelen sind selten und werden durch eine Obstruktion des Tränen-Nasen-Ganges bedingt. Symptomatisch zeigen sich Epiphora, Nasenatmungsbehinderung und eine Schwellung des medialen Kanthus. Therapeutisch erfolgt zumeist eine Eröffnung der Hasner-Klappe durch Sondierung und ggf. Intubation der Tränenwege. Wir stellen ein minimalinvasives endoskopisches Vorgehen mit Marsupialisation des endonasalen Zelenanteils vor. Auf eine zusätzliche Manipulation im Bereich des Tränenweges wird zur Vermeidung von iatrogenen Verletzungen verzichtet. Methoden Insgesamt konnten 19 Kinder (21 Augen) im Alter von 3 Tagen bis 39 Monaten in die retrospektive Auswertung eingeschlossen werden. Zwei der Patienten litten an akuter Atemnot, 7 Kinder unter rezidivierenden Infektionen mit persistierender Epiphora und 12 hatten eine akute Dakryozystitis mit orbitaler Phlegmone. Ergebnisse In allen Fällen konnte ein endonasaler Zelenanteil detektiert und endoskopisch endonasal reseziert werden. Bei 2 Kindern, die primär im Alter von 22 und 39 Monaten operiert wurden, kam es zu Rezidiven, was jeweils eine Revisionsoperation per Dakryozystorhinostomie erforderlich machte. Alle übrigen 17 Kinder waren rezidivfrei. Zusammenfassung Unsere Ergebnisse zeigen, dass eine endoskopische endonasale Marsupialisation ohne zusätzliche Intubation oder Sondierung der Tränenwege ein erfolgreiches Therapieregime für konnatale Dakryozystozelen darstellt. Iatrogen bedingte Vernarbungen, die Anlage einer Via falsa oder eine postoperative Bakteriämie können so vermieden werden. Bei älteren Kindern mit stattgehabten Entzündungen in der Vorgeschichte, sinkt die Erfolgsrate der hier vorgestellten Operationstechnik.

Background VR (Virtual Reality) has emerged as a recent treatment approach in neurorehabilitation. The feasibility of VR-guided therapy in the acute phase after stroke has not been assessed. Methods This was a cohort study of consecutive patients with suspected stroke who were admitted to the Essen University Hospital Stroke Unit between March 2022 and May 2022. All patients who had an indication for physical or occupational therapy due to upper extremity sensorimotor, cognitive or perceptual deficits were included and considered for VR-guided treatment. We excluded patients with predominant deficits in lower extremity function, since these could not be targeted with our VR system. A multidimensional approach was used to assess the feasibility of VR-guided therapy, which included characterization of eligible patients, resource utilization as well as treatment acceptance. For this purpose, we analyzed baseline and clinical characteristics, causes for withholding the treatment as well as qualitative and quantitative treatment metrics in patients who received VR-guided therapy. Results Out of 326 patients admitted with suspected stroke, n = 172 were included in our final analysis. Of these, n = 37 (21.5%) received VR-guided therapy. The most common cause for withholding treatment were neuropsychological limitations (22.9%), followed by physical impairment, comorbidity and level of consciousness alterations (all 17.8%). Patients who received VR-guided therapy tended to have better functional status and less severe neurological deficits. VR-guided sessions had a median duration of 20 min (IQR 17–29) with additional 13 min (IQR 9–17) of preparation time. In the majority of patients who received VR-guided therapy, motivation was rated equal or higher as compared with conventional treatment (76%) and therapists considered VR-guided therapy well feasible (65%). Conclusions Despite important treatment barriers, VR may provide additional opportunities to enhance functional recovery in the acute phase after stroke for selected patients. Our findings could aid in planning further randomized controlled trials which are required to refine approaches and assess the effectiveness of VR-guided therapy in the acute setting.

In recent years, knowledge about cerebrospinal cavernomas has grown considerably, leading to the development of initial guidelines and treatment recommendations. However, due to the rarity and heterogeneity of the disease, the level of evidence remains limited, leaving many questions unanswered and subject to ongoing debate. Therefore, an up-to-date review of this field's latest developments and controversies is reasonable.

Purpose The purpose of the present study was to analyze associations between different skeletal muscle quality parameters and survival in patients with hepatocellular carcinoma (HCC) undergoing treatment with transarterial chemoembolization (TACE). Methods We retrospectively enrolled 784 treatment-naïve patients with HCC undergoing TACE at six tertiary care centers between 2010 and 2020. Intramuscular adipose tissue (IMAT) and skeletal muscle density (SMD) were estimated. Myosteatosis was defined as SMD < 28.0 HU for men and < 23.8 HU for women. Furthermore, albumin-SMD score (ADS) was calculated as follows: serum albumin (g/dL) × SMD (HU). To assess the impact of muscle quality on survival, Cox regression model was used. Kaplan-Meier curves were used for survival analysis. Parameters of skeletal muscle quality were compared in univariate and multivariate regression analyses, adjusted for established risk factors. Results In the overall sample, survivors had higher SMD and ADS in comparison to non-survivors. Patients with low ADS had a lower OS than patients with high ADS (8.4 vs. 14.3 months, p < 0.001). In alcohol-induced HCC, none of the analyzed parameters of muscle quality influenced survival. In viral induced HCC, patients with low ADS had lower OS than patients with high ADS (8.8 vs. 15.7 months, p < 0.001). In patients with non-alcoholic steatohepatitis (NASH), none of the analyzed parameters of muscle quality influenced survival. Conclusions Low ADS is an independent predictor of worse OS in patients with viral-induced HCC undergoing treatment with TACE. In alcohol-induced and NASH-induced HCCs, parameters of muscle quality do not influence OS.

Stride velocity 95th centile (SV95C) is a wearable-derived endpoint representing the 5% fastest strides taken during everyday living. In July 2023, SV95C received European Medicines Agency (EMA) qualification for use as a primary endpoint in trials of patients with Duchenne muscular dystrophy (DMD) aged ≥ 4 years—becoming the first digital endpoint to receive such qualification. We present the data supporting this qualification, providing insights into the evidentiary basis of qualification as a digital clinical outcome assessment. Clinical trials, natural history studies, and patient surveys (ages 5 − 14 years) showed that SV95C is accurate, valid, reliable, sensitive, and clinically meaningful. SV95C significantly correlated with traditional DMD assessments, increased rapidly after steroid initiation (0.090 m/s 3 months post-treatment), and declined steadily in patients on stable steroid regimens. Compared with traditional assessments, SV95C demonstrated earlier sensitivity to disease progression (3 vs 9 months) and greater sensitivity at 12 months. Distribution- and anchor-based approaches revealed a change of − 0.10 to − 0.20 m/s as clinically meaningful. The EMA qualification of SV95C illustrates the willingness of regulators to accept novel digital endpoints for drug approval, setting an important precedent for the evidentiary basis of regulatory digital endpoint qualification that could transform clinical development in disorders affecting movement.

Objectives: To investigate the carbapenem resistance mechanism of a carbapenem-resistant clinical Pseudomonas aeruginosa isolate. Methods: A clinical isolate of P. aeruginosa was sent to the German National Reference Centre for multidrug-resistant Gram-negative bacteria for carbapenemase detection. Phenotypic tests for carbapenemase detection and an EDTA-combined disc test were positive, therefore PCR-screenings were done for the most prevalent metallo-β-lactamase (MBL) encoding genes. As no MBL gene could be found, whole-genome sequencing was performed. For characterization, heterologous expression in a E. coli strain with subsequent MIC testing and purification of the new MBL to determine enzyme kinetics with in vitro hydrolysis assays was performed. Results: WGS revealed the putative gene for a B3 MBL located on the chromosome between several disrupted IS elements with 67% identity to EVM-1, which was named NWM-1. MIC studies and enzyme kinetics confirmed MBL activity. No activity against ceftazidime was observed. Conclusions: The identification of NWM-1 shows the importance of WGS to identify yet unknown carbapenemases and underlines the diversity of subclass B3 β-lactamases. It also shows that although several carbapenemase variants have already been identified and characterized, there are always new variants to be found in clinical isolates.

Background Treatment planning in radiation therapy (RT) is performed on image sets acquired with commercial x‐ray computed tomography (CT) scanners. Considering an increased frequency of verification scans for adaptive RT and the advent of alternatives to x‐ray CTs, there is a need to review the requirements for image sets used in RT planning. Purpose This study aims to derive the required image quality (IQ) for the computation of the dose distribution in proton therapy (PT) regarding spatial resolution and the combination of spatial resolution and noise. The knowledge gained is used to explore the potential for dose reduction in tomography‐guided PT. Methods Mathematical considerations indicate that the required spatial resolution for dose computation is on the scale of the set‐up margins fed into the robust optimization. This hypothesis was tested by processing retrospectively 12 clinical PT cases, which reflect a variety of tumor localizations. Image sets were low‐pass filtered and were made noisy in a generic manner. Dose distributions on the modified CT scans were computed with a Monte‐Carlo dose engine. The similarity of these dose distributions with clinical ones was quantified with the gamma‐index (1 mm/1%). The potential reduction of the x‐ray exposure compared to the planning CT scan was estimated. Results Dose distributions within the irradiated volume were robust against low‐pass filtering of the CTs with kernels up to a full‐width‐at‐half‐maximum of 4 mm, that is, the gamma pass rate (1 mm/1%) was ≥$\ge$98%. The limit of the filter width was 6 mm for brain tumors and 8 mm for targets in the abdomen. These pass rates remained approximately unchanged if a limited amount of noise was added to the CT image sets. The estimated potential reductions of the x‐ray exposure were at least a factor of 20. Conclusions The requirements on IQ in terms of spatial resolution in combination with noise for computing the dose in PT are clearly lower than the IQ of current clinical planning. The results apply, for example, to ultra‐low dose x‐ray CTs, proton CTs with coarse spatial detection, and attenuation images from the joint reconstruction of time‐of‐flight PET scans.

Background In uveal melanoma patients, short-term evaluation of treatment response to hepatic artery infusion chemotherapy (HAIC) using the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria is challenging due to the diffuse metastatic spread. As liver enlargement can frequently be observed, this study aims to compare RECIST 1.1 and liver volumetry (LV) for the evaluation of HAIC treatment response. Patients and methods Treatment response was evaluated in 143 patients (mean age 65.1 ± 10.9 years, 54% female) treated by HAIC by RECIST 1.1 and LV on CT imaging performed before and after HAIC. In LV, different increases in liver volume were evaluated to set an effective threshold to distinguish between stable disease (SD) and progressive disease (PD). Overall survival (OS) was calculated as the time from first HAIC to patient death using Kaplan-Meier test and multivariate analysis was performed for RECIST 1.1 and LV. Results In the overall population, median OS (mOS) was 13.5 months (95% CI 11.2–15.8 months). In LV, a threshold of 10% increase in liver volume was suited to identify patients with significantly reduced OS (SD: 103/143 patients, mOS 15.9 months; PD: 40/143 patients, 6.6 months; p < 0.001). Compared to RECIST 1.1, LV was the only significant prognostic factor that was able to identify a decreased OS. Conclusions In uveal melanoma patients with liver metastases, LV with a threshold for liver volume increase of 10% was suitable to evaluate treatment response and would be able to be used as a valuable add-on or even alternative to RECIST 1.1.

Background and objective: The role of prostate-specific membrane antigen (PSMA)-based positron emission tomography (PET)/computed tomography (CT) in addition to magnetic resonance imaging (MRI) for local staging of prostate cancer (PC) has been poorly addressed so far. Our aim was to assess the diagnostic accuracy of PSMA PET/CT and MRI, alone and combined, for detection of extraprostatic extension (EPE) and seminal vesicle invasion (SVI) in PC. Methods: We conducted a multicenter retrospective study evaluating patients undergoing PSMA PET/CT and MRI before radical prostatectomy. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC) for detection of EPE and SVI were calculated for MRI and PSMA PET/CT alone and combined. Key findings and limitations: We included 550 patients, of whom 2%, had low-risk, 43% had intermediate-risk, and 55% had high-risk PC. Overall, 52% of patients had EPE and 21% had SVI at histopathology. Patient-based comparison of MRI versus PSMA PET/CT for detection of EPE revealed sensitivity of 60% versus 41% (p < 0.001), specificity of 77% versus 83% (p = 0.075), PPV of 75% versus 73% (p = 0.6), NPV of 64% versus 56% (p < 0.001), and AUC of 69% versus 62% (p = 0.01). Combining the modalities increased the sensitivity (73%; p < 0.001) and NPV (69%; p < 0.001) and decreased the specificity (67%; p < 0.001) and PPV (71%; p = 0.01) over MRI alone. Patient-based comparison of MRI versus PSMA PET/CT for detection of SVI revealed sensitivity of 36% versus 44% (p = 0.2), specificity of 96% versus 96% (p > 0.99), PPV of 71% versus 75% (p = 0.6), NPV of 85% versus 87% (p = 0.2), and AUC of 66% versus 70% (p = 0.2). Combining the modalities increased the sensitivity (60%; p < 0.001), NPV (90%; p < 0.001), and AUC (76%; p < 0.001) and decreased the specificity (92%; p < 0.001) over MRI alone. Limitations include the retrospective nature of the study, selection of higher-risk cases for PSMA PET/CT, and lack of central review. Conclusions and clinical implications: PSMA PET/CT has lower sensitivity for EPE detection in comparison to MRI. However, addition of PSMA PET information to MRI improved the sensitivity for EPE and SVI detection. Thus, the two modalities should be combined to guide treatment selection.

Background Pulmonary lymphangiomatosis (PL) is an ultrarare disease characterized by diffuse infiltration of the lung, pleura and/or mediastinum by abnormal lymphatic proliferation. Consented diagnostic or treatment approaches are not established. We therefore aimed to collect data on diagnostics and treatments in a cohort of patients with PL from a tertiary center for rare lung diseases. Methods Clinical, radiological and outcome data from PL patients were collected retrospectively. Results 12 patients were diagnosed between 1996 and 2022 in our center. PL was diagnosed more commonly in female (58%), never smokers (75%) and younger patients (mean age 42 years). Main clinical symptoms comprised haem- and chyloptysis (58%) and dyspnea on exertion (83%). Pulmonary function was mostly restrictive (mean VC 59%) with impaired DLCO (mean 65%). Radiological assessment mainly showed mediastinal involvement (83%), and pleural effusion (67%), pleural thickening (67%) and bronchial wall thickening (67%) while interstitial changes were rare. Diagnosis was confirmed by surgical or transbronchial cryobiopsy. 8 patients were treated with sirolimus, 3 of these combined with a surgical intervention and in one case surgical intervention was necessary 9 months after initiation of sirolimus. Clinical and radiological improvement was demonstrated for all patients treated with sirolimus. 1 patient received a lung transplant due disease progression. Survival rates were 90% after a mean follow up of at least 3 months. Conclusion This case series illustrates the variability of the clinical presentation of PL. Among our patients, those treated with sirolimus showed significant clinical, functional and radiological improvement. However, further investigation is needed to understand the pathogenesis of lymphangiomatosis in order to establish therapeutic approaches.

Background Inter-organizational partnerships and collaborations, used here interchangeably, have growing prominence across the health sector. Successful partnerships have received extensive study. However, especially for partnerships including nonprofit partners, limited attention has been given to negative factors that contribute to struggling partnerships, including failed partnerships, and/or impede potential partnerships, including unexplored and undeveloped potential partnerships. This study aimed to explore these across diverse examples of struggling and potential partnerships considered otherwise worthwhile in principle, according to leaders and managers—in 13 countries across Asia-Pacific, EU+, North America—from diverse roles and settings across the health sector. It also aimed to explore success factors they said contributed to successful partnerships. Methods Interviews were conducted with 70 practitioners in 13 countries and a wide range of roles and nonprofit, industry, and government settings, including research institutions, across the health sector. Interviews covered their examples of struggling, potential, and successful partnerships; and, factors. Interview data were analyzed inductively, employing thematic network analysis. Comments underlying themes were reviewed regarding the participants concerned to note range (e.g., regions). Results Key findings included: (1) the many negative factors and success factors identified as themes; (2) their occurrence across diverse contexts, including different regions and institutional sectors (i.e., nonprofit, industry, government); (3) the complementarity of negative factors and success factors, with each set placing different emphasis on certain topics and negative factors both broadening the overall range of topics and contributing more to literature; (4) the occurrence of most negative factors with both struggling and potential partnerships. The 255 partnerships and potential partnerships discussed included nonprofit (190/255), industry (112/255), and/or government (140/255) partners. Many spanned two different institutional sectors (147/255); 86/255 spanned one; 20/255 spanned three. Conclusions The findings suggest three takeaways for practitioners: (1) factors used to consider partnerships should reflect factors from struggling partnerships and/or potential partnerships, plus successful partnerships; (2) negative factors can highlight opportunities to advance partnerships, individually and systematically; (3) practitioners should consider developing frameworks of factors from literature and experience to facilitate judicious consideration of partnerships and inform approaches, lessons drawn, and potential partnerships sought. Struggling and potential partnerships merit scholarly attention.

Aims Traditional cardiovascular (CV) biomarkers (high‐sensitivity troponinT [hsTnT] and N‐terminal pro‐B‐type natriuretic peptide [NT‐proBNP]) are important to monitor cancer patients' cardiac function and to assess prognosis. Newer CV biomarkers (mid‐regional pro‐adrenomedullin [MR‐proADM], C‐terminal pro‐arginine vasopressin [copeptin], and mid‐regional pro‐atrial natriuretic peptide [MR‐proANP]) might outperform traditional biomarkers. Methods and results Overall, 442 hospitalized cancer patients without significant CV disease or current infection were enrolled (61 ± 15 years, 52% male, advanced cancer stage: 85%) and concentrations of CV biomarkers were analysed. Differences in echocardiographic, clinical, laboratory parameters were assessed. Patients were followed for up to 69 months for all‐cause mortality. In univariable analyses, MR‐proADM, hsTnT, copeptin, MR‐proANP, and NT‐proBNP predicted all‐cause mortality. In multivariable analyses (adjusted for sex, age, Eastern Cooperative Oncology Group performance status, estimated glomerular filtration rate [eGFR], C‐reactive protein, anti‐cancer therapy, reason for hospitalization, cancer stage and type), only MR‐proADM remained an independent predictor of mortality (MR‐proADM per 1 ln: hazard ratio [HR] 2.27, 95% confidence interval [CI] 1.47–3.50], p < 0.001). MR‐proADM had the highest area under the curve (AUC) using receiver operating characteristic analysis (AUC [95% CI] 0.74 [0.69–0.79]; hsTnT: AUC 0.69; copeptin: AUC 0.66; MR‐proANP: AUC 0.63; NT‐proBNP: AUC 0.62). Optimal cut‐point for mortality prediction with MR‐proADM was 0.94 nmol/L (HR 2.43 [95% CI 1.92–3.06], p < 0.001). Patients with MR‐proADM >0.94 nmol/L were older, more often had cancer stage IV, showed reduced performance status, eGFR, haemoglobin, diastolic left ventricular function, and elevated systolic pulmonary artery pressure. Conclusion MR‐proADM is an independent predictor of mortality in advanced stage, hospitalized cancer patients without significant CV disease or current infection. The optimal MR‐proADM cut‐point for mortality prediction was 0.94 nmol/L with hazards for mortality being approximately 2.5 times higher. There was a continuous increase in mortality risk with stepwise increase of MR‐proADM concentrations. Elevated concentrations of MR‐proADM were also associated with reduced performance status and mildly reduced left ventricular diastolic function as well as higher age and more often cancer stage IV.