Abstract
Early identification and diagnosis of sepsis and septic shock is vitally important; despite appropriate management, mortality and morbidity rates remain high. For this reason, many biomarkers and screening systems have been investigated in accordance with the precision medicine concept. A narrative review was conducted to assess the role of mid-regional pro-adrenomedullin (MR-proADM) as a biomarker for sepsis and septic shock. Relevant studies were collected via an electronic PubMed, Web of Science, and The Cochrane Library search. The review focused on both diagnosis and prognosis in patients with sepsis and septic shock and specifically in subpopulations of patients with sepsis and septic shock with burns or malignant tumors. No exclusion criteria regarding age, sex, intensive care unit admission, follow-up duration, or co morbidities were used so as to maximize sensitivity and due to lack of randomized controlled trials, opinion paper and reviews were also included in this review. A total of 22 studies, one opinion paper, and one review paper were investigated. MR-proADM levels were found to be useful in assessing patients’ initial evolution and become even more useful during follow-up with increased area under curve values in the mortality prognosis by exceeding values of 0.8 in the data shown in several studies. These results also improve along with other biomarkers or severity scores and especially correlate with the organ failure degree. The results of this study indicate that MR-proADM is a good biomarker for the diagnosis and prognosis of sepsis and septic shock patients as well as for organ failure. Although several publications have discussed its role as a biomarker for pneumonia, its value as a biomarker for sepsis and septic shock should now be assessed in randomized controlled trials and more collaborative prospective studies with larger patient samples.
Highlights
Adrenomedullin (ADM) plays an important role in the inflammation process and in progression from sepsis to septic shock
We review the role of MR-proADM as a biomarker for sepsis and septic shock
Enguix-Armada et al analyzed 388 patients to determine whether the combination of C-reactive protein (CRP), procalcitonin (PCT), presepsin, or SCD14-ST and MR-proADM measured in the first
Summary
Adrenomedullin (ADM) plays an important role in the inflammation process and in progression from sepsis to septic shock. Because of the rapid clearance of circulating ADM from the circulation and its binding protein (complement factor H), it is difficult to detect plasma ADM levels. Healthcare 2018, 6, 110 by standard immunoassay. The mid-regional fragment of pro-adrenomedullin (MR-proADM) is more stable and demonstrates the levels of the active ADM peptide [3]. Sepsis and septic shock remain a major healthcare problem worldwide, with high mortality rates. Identification is vital for reducing these rates [4]. For this reason, many biomarkers and screening systems have been investigated in accordance with the precision medicine concept [5]
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