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Vol. 42. Num. 7.October 2018
Pages e16-e18Pages 397-460
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Vol. 42. Num. 7.October 2018
Pages e16-e18Pages 397-460
DOI: 10.1016/j.medine.2017.10.013
Assessment of adrenomedullin and proadrenomedullin as predictors of mortality in septic patients: A systematic review and meta-analysis
Evaluación de adrenomedulina y proadrenomedulina como factores pronóstico de la mortalidad en pacientes sépticos: revisión sistemática y metaanálisis
Q. Li1, B.S. Wang1, L. Yang, C. Peng, L.B. Ma, C. Chai
Corresponding author
3rd Department of General Surgery, First Hospital of Lanzhou University, Lanzhou 730000, China
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Table 1. Characteristics of included studies.

To ascertain the ability of adrenomedullin (ADM) and proadrenomedullin (proADM) to predict mortality in sepsis patients.


A systematic literature search was made of the PubMed, EMBASE, Cochrane and China National Knowledge Infrastructure (CNKI) databases before May 2017, supplemented by manual searches of references. A meta-analysis of high-quality clinical studies was subsequently performed to assess the association between ADM/proADM and mortality risk among patients with sepsis.


Thirteen studies involving 2556 patients were included in the study.


Two reviewers independently identified articles, extracted data, assessed quality and cross-checked the results. The predictive values of ADM and proADM referred to mortality were assessed by relative risk (RR). The overall diagnostic accuracy of ADM and proADM in application to sepsis was pooled according to a bivariate model. Publication bias was assessed using Deek's funnel plot asymmetry test.


Elevated ADM or proADM levels were associated with increased mortality (pooled RR=3.31; 95%CI 2.31–4.75). Subgroup analyses indicated the pooled RRs were 3.12 (95%CI 1.75–5.56) and 3.43 (95%CI 2.21–5.31) for ADM and proADM, respectively. The pooled sensitivity and specificity were 0.72 (95%CI 0.64–0.78) and 0.77 (95%CI 0.69–0.83), respectively. The overall area under the summary receiver operating characteristic (SROC) curve was 0.80 (95%CI 0.77–0.84). Publication bias was not statistically significant.


Both ADM and proADM might serve as useful markers for predicting the prognosis of sepsis.


Establecer la capacidad de la adrenomedulina (ADM) y la proadrenomedulina (proADM) para predecir la mortalidad en pacientes sépticos.


Se llevó a cabo una búsqueda sistemática de la literatura científica en las bases de datos PubMed, EMBASE, Cochrane y China National Knowledge Infrastructure (CNKI) antes de mayo de 2017, complementada con búsquedas manuales de referencia. Posteriormente, se realizó un metaanálisis de estudios clínicos de alta calidad para evaluar la asociación entre ADM/proADM y el riesgo de mortalidad en pacientes con sepsis.


En este análisis se incluyeron 30 estudios en los que participó un total de 2.556 pacientes.


Dos revisores identificaron de forma independiente los artículos, extrajeron los datos, evaluaron la calidad y realizaron verificaciones cruzadas de los resultados. Se evaluó el valor de ADM y proADM como factor pronóstico de mortalidad a partir del riesgo relativo (RR). La precisión global del diagnóstico con ADM y proADM en pacientes con sepsis se agrupó utilizando un modelo de 2 variables. Se evaluó el sesgo de publicación utilizando una prueba de Deek para asimetría de gráfico en embudo.


Las concentraciones elevadas de ADM o proADM se asociaron a un aumento de la mortalidad (RR agrupado: 3,31; IC del 95%: 2,31-4,75). Los análisis por subgrupos indicaron que los RR agrupados eran de 3,12 (IC del 95%: 1,75-5,56) y 3,43 (IC del 95%: 2,21-5,31) para ADM y proADM, respectivamente. La sensibilidad y especificidad agrupadas fueron 0,72 (IC del 95%: 0,64-0,78) y 0,77 (IC del 95%: 0,69-0,83), respectivamente. El área global bajo la curva (SROC) fue de 0,80 (IC del 95%: 0,77-0,84). El sesgo de publicación no fue estadísticamente relevante.


Tanto ADM como proADM pueden ser marcadores útiles para predecir el pronóstico de pacientes con sepsis.

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