Midregional-proAdrenomedullin as a prognostic tool in sepsis and septic shock: A systematic review and meta-analysis
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Published on: September 22, 2020
Emanuele Valeriani1,2, Antonio Falletta3, Daniele Pastori4
1Department of General Surgery and Surgical Specialty, Sapienza University of Rome, Rome, Italy.
Background:
Midregional-proAdrenomedullin (MR-proADM) has been recently proposed as a tool in patients with sepsis and septic shock. Our aim was to evaluate the prognostic role of MR-proADM in hospitalized patients with sepsis and septic shock.
Methods:
PRISMA guideline was followed. MEDLINE and EMBASE were searched up to June 2023. Primary outcome was mean difference in MR-proADM among survivors and nonsurvivors, secondary outcome mean difference in MR-proADM according to infection severity and type. Risk of bias was evaluated using Newcastle-Ottawa scale for observational studies and Cochrane tool for randomized trials. Pooled mean differences (MD) with corresponding 95% confidence intervals (CIs) were calculated in a random-effects model.
Results:
Twenty-four studies included 6730 adult patients (1208 nonsurvivors and 5522 survivors) and three studies included 195 paediatric patients (30 nonsurvivors and 165 survivors). A total of 10, 4 and 13 studies included, respectively, patients with sepsis (3602 patients), septic shock (386 patients) and a mixed population (2937 patients). Twenty-one studies included patients with different source of infection, three with pneumonia and one with a catheter-related infection. Most studies (n = 12) had a follow-up of 28 days. In adult cohort, pooled mean difference between nonsurvivors and survivors of MR-proADM was 2.55 mmol/L (95% CI: 1.95-3.15) with higher values in patients with septic shock (4.25 mmol/L; 95% CI, 2.23-6.26 mmol/L) than in patients with sepsis (1.77 mmol/L; 95% CI: 1.11-2.44 mmol/L). In paediatric cohort, pooled mean difference was 3.11 mmol/L (95% CI: -0.02-6.24 mmol/L).
Conclusions:
Higher values of MR-proADM are detectable in nonsurvivors adult and paediatric-hospitalized patients with sepsis or septic shock.
Insights
Midregional-proAdrenomedullin (MR-proADM) levels are higher in non-survivors of sepsis and septic shock. This biomarker can help predict outcomes in both adult and pediatric hospitalized patients with these critical conditions.
Area of Science:
- Biomarkers in critical care medicine
- Prognostic indicators in infectious diseases
Background:
- Midregional-proAdrenomedullin (MR-proADM) is a novel biomarker investigated for its role in sepsis and septic shock.
- Evaluating the prognostic value of MR-proADM is crucial for improving patient outcomes in these life-threatening conditions.
Approach:
- A systematic review and meta-analysis following PRISMA guidelines was conducted, searching MEDLINE and EMBASE up to June 2023.
- Pooled mean differences in MR-proADM levels between survivors and non-survivors were calculated using a random-effects model.
- Risk of bias was assessed using established tools for observational and randomized studies.
Key Points:
- The analysis included 24 studies with 6730 adult patients and 3 studies with 195 pediatric patients.
- Higher MR-proADM levels were observed in non-survivors compared to survivors in both adult (MD: 2.55 mmol/L) and pediatric cohorts (MD: 3.11 mmol/L).
- Elevated MR-proADM was particularly pronounced in patients with septic shock compared to those with sepsis alone.
Conclusions:
- MR-proADM is a significant prognostic biomarker in hospitalized patients with sepsis or septic shock.
- Consistently higher MR-proADM values are detected in non-survivors across both adult and pediatric populations.
- This finding supports the utility of MR-proADM in risk stratification and outcome prediction for sepsis and septic shock.
