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Meta-Analysis
. 2023 May 8;23(1):305.
doi: 10.1186/s12879-023-08275-z.

Circulating mid-regional proadrenomedullin is a predictor of mortality in patients with COVID-19: a systematic review and meta-analysis

Na Wang #  1 , Lushan Liu #  1 , Wei He  1 , Na Shang  1 , Junyu Li  1 , Zhou Qin  1 , Xiaoxia Du  2
Affiliations
Meta-Analysis

Circulating mid-regional proadrenomedullin is a predictor of mortality in patients with COVID-19: a systematic review and meta-analysis

Na Wang et al. BMC Infect Dis. .

Abstract

Background: Although there is increasing understanding of the changes in the laboratory parameters of Coronavirus disease 2019 (COVID-19), the correlation between circulating Mid-regional Proadrenomedullin (MR-proADM) and mortality of patients with COVID-19 is not fully understood. In this study, we conducted a systematic review and meta-analysis to evaluate the prognostic value of MR-proADM in patients with COVID-19.

Methods: The PubMed, Embase, Web of Science, Cochrane Library, Wanfang, SinoMed and Chinese National Knowledge Infrastructure (CNKI) databases were searched from 1 January 2020 to 20 March 2022 for relevant literature. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to assess quality bias, STATA was employed to pool the effect size by a random effects model, and potential publication bias and sensitivity analyses were performed.

Results: 14 studies comprising 1822 patients with COVID-19 met the inclusion criteria, there were 1145 (62.8%) males and 677 (31.2%) females, and the mean age was 63.8 ± 16.1 years. The concentration of MR-proADM was compared between the survivors and non-survivors in 9 studies and the difference was significant (P < 0.01), I2 = 46%. The combined sensitivity was 0.86 [0.73-0.92], and the combined specificity was 0.78 [0.68-0.86]. We drew the summary receiver operating characteristic (SROC) curve and calculated the area under curve (AUC) = 0.90 [0.87-0.92]. An increase of 1 nmol/L of MR-proADM was independently associated with a more than threefold increase in mortality (odds ratio (OR) 3.03, 95% confidence interval (CI) 2.26-4.06, I2 = 0.0%, P = 0.633). The predictive value of MR-proADM for mortality was better than many other biomarkers.

Conclusion: MR-proADM had a very good predictive value for the poor prognosis of COVID-19 patients. Increased levels of MR-proADM were independently associated with mortality in COVID-19 patients and may allow a better risk stratification.

Keywords: COVID-19; Meta-analysis; Mid-regional Proadrenomedullin; Mortality.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Research screening flowchart
Fig. 2
Fig. 2
Assessment of risk of bias for the studies
Fig. 3
Fig. 3
Forest plots showing WMD with 95% CI for the concentration of MR-proADM Comparing survivors and non-survivors in a random-effect model. CI, confidence interval; WMD, weighted mean difference
Fig. 4
Fig. 4
Forest plot of the sensitivity and specificity of MR- proADM to predict mortality in COVID-19 patients. CI, confidence interval
Fig. 5
Fig. 5
Summary receiver operating characteristics (SROC) curve for the included studies. SENS, sensitivity; SPEC, specificity; AUC, area under the curve
Fig. 6
Fig. 6
Effect size analysis for mortality in COVID-19 patients with MR-proADM elevation
Fig. 7
Fig. 7
Begg’s test for publication bias
Fig. 8
Fig. 8
Sensitivity analysis of the mortality in COVID-19 patients with MR-proADM elevation
See this image and copyright information in PMC

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