Microbiology Innovation and Research UNIT, Department of Infection, University Hospitals Southampton NHS Foundation Trust, Southampton, UK.
School of Medicine, University of Southampton, Southampton, UK.
Expert Rev Mol Diagn. 2021 Apr;21(4):397-404. doi: 10.1080/14737159.2021.1902312. Epub 2021 Mar 29.
Mid-regional proadrenomedullin (MR-proADM), a novel biomarker, has recently gained interest particularly with regards to its potential in assisting clinicians' decision making in patients with suspicion of infection in the emergency department (ED). A group of international experts, with research and experience in MR-proADM applications, produced this review based on their own experience and the currently available literature.
The review provides evidence related to MR-proADM as a triaging tool in avoiding unnecessary admissions to hospital and/or inadequate discharge, and identifying patients most at risk of deterioration. It also covers the use of MR-proADM in the context of COVID-19. Moreover, the authors provide a proposal on how to incorporate MR-proADM into patients' clinical pathways in an ED setting.
The data we have so far on the application of MR-proADM in the ED is promising. Incorporating it into clinical scoring systems may aid the clinician's decision making and recognizing the 'ill looking well' and the 'well looking ill' sooner. However there are still many gaps in our knowledge especially during the ongoing COVID-19 waves. There is also a need for cost-effectiveness analysis studies especially in the era of increasing cost pressures on health systems globally.
中区域原促肾上腺皮质素（MR-proADM）是一种新型生物标志物，最近引起了人们的关注，特别是在协助临床医生对急诊科（ED）疑似感染患者做出决策方面具有潜在应用价值。一组在 MR-proADM 应用方面具有研究和经验的国际专家，根据他们自己的经验和当前可用的文献，撰写了这篇综述。
这篇综述提供了与 MR-proADM 作为分诊工具相关的证据，用于避免不必要的住院和/或不充分的出院，并识别最有可能恶化的患者。它还涵盖了 MR-proADM 在 COVID-19 背景下的应用。此外，作者还就如何在 ED 环境中将 MR-proADM 纳入患者的临床路径提出了建议。
我们目前在 ED 中应用 MR-proADM 的数据很有前景。将其纳入临床评分系统可能有助于临床医生的决策，并更早地识别出“看似健康的病人实际上病情危重”和“看似病重的病人实际上病情较轻”。然而，我们的知识仍然存在许多空白，尤其是在当前持续的 COVID-19 浪潮期间。在全球医疗系统成本压力不断增加的时代，还需要进行成本效益分析研究。
