**7.1 MR-proADM—mid-regional proadrenomedullin**

ADM is a multipotent regulatory peptide with several biological activities including vasodilator, positive inotropic, diuretic, natriuretic, and bronchodilator. It is widely expressed throughout the body, including bone, adrenal cortex, kidney, lung, blood vessels, and heart. ADM is even present in pulmonary pneumocytes type 2, smooth muscle cells, neurons, and immune cells. It is upregulated by hypoxia, inflammatory cytokines, bacterial products, and shear stress. As ADM measurement is complicated, mid-regional proadrenomedullin (MR-proADM) is being considered as an estimate of ADM [8–10]. High levels of MR-proADM are reported in septic patients. These have been shown to be particularly specific in prognostic value, not only for early diagnosis in the context of patients initially presenting to the Emergency Department (ED) but also for risk stratification and prognosis in critically ill patients in Intensive Care Units (ICU). A study from Italy in 2020 aimed to describe the utility of MR-proADM as a prognostic biomarker in severe COVID-19 infection. Fifty seven patients who were admitted to the ICU with COVID-19 infection were studied. Multivariate logistic regression models demonstrated that MR-proADM was an independent predictor of mortality [11].
