Pro-adrenomedullin as a prognostic biomarker in patients with heart failure: A systematic review and meta-analysis

Pro-adrenomedullin (proADM) involved in cardiovascular hemostasis, has shown promise as a prognostic biomarker in heart failure (HF). However, it's precise role in predicting HF outcomes has yet to be defined. We conducted a systematic review and meta-analysis to determine whether proADM can effectively predict outcomes in patients with HF. We systemtically searched Pubmed, Cochrane, Web of Science, and Scopus for studies on proADM levels in adults (≥18 years) diagnosed with HF. Cohort studies, case-control studies, and randomized controlled trials were considered. The primary outcomes were mortality and hospitalization, with the risk of bias assessed using the QUIPs tool. A random effects meta-analysis was conducted to report pooled hazard ratio (HR) and 95% confidence intervals. Our search identified 956 studies, of which 25 met the inclusion criteria after full-text screening, encompassing a total of 13,915 patients. ProADM emerged as a robust predictor of mortality (HR = 2.46, 95% CI [2.02-3.01]) and combined mortality/hospitalization (HR = 2.96, 95% CI [2.17-4.04]). Notably, each 1-log-unit (nmol/L) increase in proADM was associated with a 196% higher risk of mortality or hospitalization and a 146% higher risk of mortality. ProADM shows significant potential as a prognostic biomarker for HF, with elevated levels linked to a higher risk of mortality and hospitalization. Future research should focus on integrating proADM into risk assessment tools for predicting worsening HF events, as this could influence management guidelines and reshape our approach to treating HF patients.