Proadrenomedullin in Sepsis and Septic Shock: A Role in the Emergency Department

Abstract

Sepsis and septic shock represent a leading cause of mortality in the Emergency Department (ED) and in the Intensive Care Unit (ICU). For these life-threating conditions, different diagnostic and prognostic biomarkers have been studied. Proadrenomedullin (MR-proADM) is a biomarker that can predict organ damage and the risk of imminent death in patients with septic shock, as shown by a large amount of data in the literature. The aim of our narrative review is to evaluate the role of MR-proADM in the context of Emergency Medicine and to summarize the current knowledge of MR-proADM as a serum indicator that is useful in the Emergency Department (ED) to determine an early diagnosis and to predict the long-term mortality of patients with sepsis and septic shock. We performed an electronic literature review to investigate the role of MR-proADM in sepsis and septic shock in the context of ED. We searched papers on PubMed®, Cochrane®, UptoDate®, and Web of Science® that had been published in the last 10 years. Data extracted from this literature review are not conclusive, but they show that MR-proADM may be helpful as a prognostic biomarker to stratify the mortality risk in cases of sepsis and septic shock with different degrees of organ damage, guiding emergency physicians in the diagnosis and the succeeding therapeutic workup. Sepsis and septic shock are conditions of high complexity and have a high risk of mortality. In the ED, early diagnosis is crucial in order to provide an early treatment and to improve patient survival. Diagnosis and prognosis are often the result of a combination of several tests. In our opinion, testing for MR-proADM directly in the ED could contribute to improving the prognostic assessment of patients, facilitating the subsequent clinical management and intensive treatment by the emergency physicians, but more studies are needed to confirm these results.

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

“…However, although the total number of patients involved in the studies is increasing, there is a huge variation in terms of population, outcome, and methods of assessing MR-proADM ( Table 1 ). The prominent discrepancies that had already emerged in studies on proADM in patients with sepsis and septic shock [ 36 ] were further enhanced in the pandemic setting.…”

Pentraxin-3 Is a Strong Biomarker of Sepsis Severity Identification and Predictor of 90-Day Mortality in Intensive Care Units via Sepsis 3.0 Definitions

“…It is involved in the defense of specific pathogens and regulation of inflammatory responses [14,15]. Recently, studies suggest that PTX3, along with other biomarkers (such as Interleukin-6 (IL-6), PCT, troponin T, monocyte chemoattractant protein 1 (MCP), proadrenomedullin (proADM), or angiopoietin (Ang) 1/2)) are closely relevant to the severity of patients with sepsis and septic shock and outcome prediction of sepsis and may be a potential biomarker of disease stratification [16][17][18][19][20][21][22].…”

The Interplay between Host Defense, Infection, and Clinical Status in Septic Patients: A Narrative Review

“…Its diagnostic and prognostic value has been investigated in several clinical studies, which confirmed pro-ADM as a good biomarker in assessing a patient’s initial state, evolution, and prognosis. Uncertainties remain about the best cut-off for the early diagnosis of sepsis and for predicting patient prognosis, and further studies are needed to highlight several dark gaps about pro-ADM release kinetic and average half-life in the bloodstream in order to reduce the risk of false-positive or -negative results [ 126 , 127 ].…”