Midregional proadrenomedullin for prognosis in community-acquired pneumonia: a systematic review
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Rodrigo Cavallazzi1, Karim El-Kersh, Emran Abu-Atherah
1Department of Medicine, Division of Pulmonary, Critical Care and Sleep Disorders Medicine, University of Louisville, Louisville, KY, USA. r0cava01@louisville.edu
Introduction:
The initial prognostic assessment of patients with community-acquired pneumonia( CAP) has important clinical implications. We hypothesized that midregional proadrenomedullin(MR-proADM) is a valuable test for the prediction of outcomes in patients with CAP.Methods: We performed a systemic review of the literature and a meta-analysis to evaluate the prognostic value of MR-proADM for short and long-term mortality in patients with CAP.Results: Twelve studies were included in the systematic review. Elevated MR-proADM was associated with an increase in short-term mortality (OR Z 6.8; 95% CI: 4.65-10.13; P value < 0.001) and complications (OR = 5.0; 95% CI: 3.86-6.49; P value < 0.001). The pooled analysis of 4 studies showed an improvement in the discriminant ability by 8% (95% CI: 2%e14%)when MR-proADM was added to CURB-65/CRB-65. Studies that reported long-term prognosis indicated an increased risk of death in patients with elevated MR-proADM.Conclusion: Elevated level of MR-proADM is significantly associated with both short-term mortality and complications in patients with CAP. Studies also indicate that MR-proADM has prognostic value for prediction of long-term mortality in these patients. The addition of MR-proADM improves the discriminant ability of CURB-65/CRB-65.
Insights
Midregional proadrenomedullin (MR-proADM) effectively predicts outcomes in community-acquired pneumonia (CAP). Elevated MR-proADM indicates higher short-term mortality and complications, improving current prognostic tools.
Area of Science:
- Biomarkers in Infectious Diseases
- Clinical Prognostics
- Respiratory Medicine
Background:
- Accurate prognostic assessment is crucial for community-acquired pneumonia (CAP) patient management.
- Midregional proadrenomedullin (MR-proADM) is a potential biomarker for predicting CAP outcomes.
Purpose of the Study:
- To systematically review and meta-analyze the prognostic value of MR-proADM in CAP patients.
- To evaluate MR-proADM's association with short-term and long-term mortality and complications.
Main Methods:
- Systematic literature review and meta-analysis.
- Inclusion of twelve studies evaluating MR-proADM in CAP.
- Pooled analysis of MR-proADM's impact on mortality and complications.
Main Results:
- Elevated MR-proADM significantly correlated with increased short-term mortality (OR 6.8) and complications (OR 5.0).
- Adding MR-proADM to CURB-65/CRB-65 improved discriminant ability by 8%.
- Long-term prognosis studies indicated higher mortality risk with elevated MR-proADM levels.
Conclusions:
- Elevated MR-proADM is a significant predictor of short-term mortality and complications in CAP.
- MR-proADM demonstrates prognostic value for long-term mortality in CAP patients.
- Incorporating MR-proADM enhances the predictive accuracy of existing CAP severity scores.