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Review
. 2022 Aug 4;11(15):4543.
doi: 10.3390/jcm11154543.

Proadrenomedullin in the Management of COVID-19 Critically Ill Patients in Intensive Care Unit: A Systematic Review and Meta-Analysis of Evidence and Uncertainties in Existing Literature

Giorgia Montrucchio  1   2 , Eleonora Balzani  1 , Davide Lombardo  1 , Alice Giaccone  1 , Anna Vaninetti  1 , Giulia D'Antonio  1 , Francesca Rumbolo  3 , Giulio Mengozzi  3 , Luca Brazzi  1   2
Affiliations
Review

Proadrenomedullin in the Management of COVID-19 Critically Ill Patients in Intensive Care Unit: A Systematic Review and Meta-Analysis of Evidence and Uncertainties in Existing Literature

Giorgia Montrucchio et al. J Clin Med. .

Abstract

Mid-regional proadrenomedullin (MR-proADM) is a new biomarker of endothelial damage and its clinical use is increasing in sepsis and respiratory infections and recently in SARS-CoV-2 infection. We conducted a systematic review and meta-analysis to clarify the use of MR-proADM in severe COVID-19 disease. After Pubmed, Embase, and Scopus search, registries, and gray literature, deduplication, and selection of full-texts, we found 21 studies addressing the use of proadrenomedullin in COVID-19. All the studies were published between 2020 and 2022 from European countries. A total of 9 studies enrolled Intensive Care Unit (ICU) patients, 4 were conducted in the Emergency Department, and 8 had mixed populations. Regarding the ICU critically ill patients, 4 studies evaluating survival as primary outcome were available, of which 3 reported completed data. Combining the selected studies in a meta-analysis, a total of 252 patients were enrolled; of these, 182 were survivors and 70 were non-survivors. At the admission to the ICU, the average MR-proADM level in survivor patients was 1.01 versus 1.64 in non-survivor patients. The mean differences of MR-proADM values in survivors vs. non-survivors was −0.96 (95% CI from −1.26, to −0.65). Test for overall effect: Z = 6.19 (p < 0.00001) and heterogeneity was I2 = 0%. MR-proADM ICU admission levels seem to predict mortality among the critical COVID-19 population. Further, prospective studies, focused on critically ill patients and investigating a reliable MR-proADM cut-off, are needed to provide adequate guidance to its use in severe COVID-19.

Keywords: COVID-19; MR-proADM; SARS-CoV-2; biomarkers; endothelitis; intensive care; proadrenomedullin.

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Conflict of interest statement

All the authors declare that they have no conflict of interest in the field of the present article.

Figures

Figure 1
Figure 1
PRISMA flow-diagram. The reasons for exclusion: reason 1: papers which did not consider ICU population; reason 2: papers which evaluated different outcome (i.e., renal replacement therapy, superinfections); reason 3: analyzed MR-proADM levels among children versus adult patients; reason 4: considered pro-ADM levels with a different technique (bioactive ADM); reason 5: presented a population already included in a previously published study.
Figure 2
Figure 2
Forest plot of the hypothetical meta-analyzed results [14,28,33]. One of the four studies selected could not be included as it did not report the standard deviation. Analysis conducted with Review manager 5.4 [11].
See this image and copyright information in PMC

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