Innovations in clinical neuroscience · 2026
Diagnostic and Prognostic Value of Adrenomedullin in Acute Ischemic and Hemorrhagic Strokes: A Systematic Review and Meta-Analysis.
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Zarei Hamed, Vazirizadeh-Mahabadi Mohammadhossein, Saadatipour Narges, Pazhooha Maryam, Hosseini Mostafa, Yousefifard Mahmoud
Аннотация
BACKGROUND: Early detection and outcome prediction of stroke are crucial for enhancing poststroke care. We explored the diagnostic and prognostic potential of bioactive adrenomedullin (bio-ADM) in stroke through a systematic review and meta-analysis.
METHODS: Medline, Embase, Scopus, and Web of Science were searched for studies measuring bio-ADM in patients with stroke. Diagnostic outcomes were confirmed via imaging, while prognostic outcomes included mortality and modified Rankin Scale (mRS). For meta-analysis, standardized mean differences (SMDs), pooled odds ratios (ORs), and sensitivity/specificity were synthesized.
RESULTS: Ten articles were included. Bio-ADM levels were significantly higher in patients with stroke compared to nonstroke control groups (SMD: 1.47; 95% confidence interval [CI]: 0.98-1.97). Subgroup analyses of acute ischemic stroke (SMD: 1.22; 95% CI: 0.34-2.11) and acute hemorrhagic stroke (SMD: 1.67; 95% CI: 1.07-2.26) demonstrated similar findings. Bio-ADM levels within the first 24 hours of a stroke were significantly higher in patients who died compared to those who survived (SMD: 1.35; 95% CI: 1.08-1.61). Pooled data analysis from multivariate models demonstrated no independent association between increased bio-ADM levels within the first 24 hours of admission and mortality (pooled adjusted OR: 1.11; 95% CI: 0.97-1.27; P=0.135). Sensitivity and specificity for mortality prediction were 0.617 (95% CI: 0.516-0.709) and 0.850 (95% CI: 0.772-0.905), respectively. Bio-ADM levels were also higher in patients with mRS score of 3 to 6 compared to those with mRS score of 0 to 2 (SMD: 0.48; 95% CI: 0.16-0.80).
CONCLUSION: Bio-ADM is significantly elevated in both hemorrhagic and ischemic strokes and associated with mortality and poor outcomes, though it is not independently predictive of death.
METHODS: Medline, Embase, Scopus, and Web of Science were searched for studies measuring bio-ADM in patients with stroke. Diagnostic outcomes were confirmed via imaging, while prognostic outcomes included mortality and modified Rankin Scale (mRS). For meta-analysis, standardized mean differences (SMDs), pooled odds ratios (ORs), and sensitivity/specificity were synthesized.
RESULTS: Ten articles were included. Bio-ADM levels were significantly higher in patients with stroke compared to nonstroke control groups (SMD: 1.47; 95% confidence interval [CI]: 0.98-1.97). Subgroup analyses of acute ischemic stroke (SMD: 1.22; 95% CI: 0.34-2.11) and acute hemorrhagic stroke (SMD: 1.67; 95% CI: 1.07-2.26) demonstrated similar findings. Bio-ADM levels within the first 24 hours of a stroke were significantly higher in patients who died compared to those who survived (SMD: 1.35; 95% CI: 1.08-1.61). Pooled data analysis from multivariate models demonstrated no independent association between increased bio-ADM levels within the first 24 hours of admission and mortality (pooled adjusted OR: 1.11; 95% CI: 0.97-1.27; P=0.135). Sensitivity and specificity for mortality prediction were 0.617 (95% CI: 0.516-0.709) and 0.850 (95% CI: 0.772-0.905), respectively. Bio-ADM levels were also higher in patients with mRS score of 3 to 6 compared to those with mRS score of 0 to 2 (SMD: 0.48; 95% CI: 0.16-0.80).
CONCLUSION: Bio-ADM is significantly elevated in both hemorrhagic and ischemic strokes and associated with mortality and poor outcomes, though it is not independently predictive of death.