Adrenomedullin For Prediction Of Mortality In Patients With Sepsis:A Meta-analysis

Background: Recognition the sepsis with high mortality is still challenging for the sepsis surviving campaign. Recently, adrenomedullin(ADM) or Mid Regional proadrenomedullin(MR-proADM) has been identified a potential prognostic biomarker. The purpose of this meta-analysis was to investigate the value of elevated ADM or MR-proADM in predicting the mortality in patients with sepsis.Methods: We searched the PubMed, Embase and the Cochrane Central Register of Controlled Trials(date to August 29, 2015). Studies that could construct a 2 × 2 contingency table with data about all-cause mortality in adult septic patients with either plasma ADM or MR-proADM measurement were included. The Review Manager and Meta-Disc software were used for meta-analysis.Results: A total of 10 studies encompassing 1,197 patients were included. Elevated ADMs was found to be significantly associated with increased risk of mortality(odds ratio(OR) 9.26, 95% confidence interval(CI) 5.49- 15.61, P < 0.00001). The pooled sensitivity and specificity were 74%(95% CI 70- 79) and 69%(95% CI 66- 72). It corresponded to positive and negative likelihood ratios, of 3.40(95% CI: 2.37- 4.89) and 0.40(95% CI: 0.27- 0.58) respectively. The area under the summary receiver operating characteristic curve(SROC) was 0.82(Q* =0.75).Conclusions: Elevated ADM or MR-proADM may be a useful biomarker to predict the mortality of septic patients. However, further studies with adequate sample and follow-up term to pinpoint the optimal cut-off point are needed.