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The vasoactive peptide MR-pro-adrenomedullin in COVID-19 patients: an observational study
Claudia Gregoriano1, Daniel Koch1, Alexander Kutz1
1Medical University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.
Objectives:
Midregional pro-adrenomedullin (MR-proADM) is a vasoactive peptide with key roles in reducing vascular hyperpermeability and thereby improving endothelial stability during infection. While MR-proADM is useful for risk stratification in patients with sepsis, clinical data about prediction accuracy in patients with severe acute respiratory syndrome coronavirus 2 disease (COVID-19) is currently missing.
Methods:
We included consecutively adult patients hospitalized for confirmed COVID-19 at a tertiary care center in Switzerland between February and April 2020. We investigated the association of MR-proADM levels with in-hospital mortality in logistic regression and discrimination analyses.
Results:
Of 89 included COVID-19 patients, 19% (n=17) died while in the hospital. Median admission MR-proADM levels (nmol/L) were increased almost 1.5-fold increased in non-survivors compared to survivors (1.3 [interquartile range IQR 1.1-2.3]) vs. 0.8 [IQR 0.7-1.1]) and showed good discrimination (area under the curve 0.78). An increase of 1 nmol/L of admission MR-proADM was independently associated with a more than fivefold increase in in-hospital mortality (adjusted odds ratio of 5.5, 95% confidence interval 1.4-21.4, p=0.015). An admission MR-proADM threshold of 0.93 nmol/L showed the best prognostic accuracy for in-hospital mortality with a sensitivity of 93%, a specificity of 60% and a negative predictive value of 97%. Kinetics of follow-up MR-proADM provided further prognostic information for in-hospital treatment.
Conclusions:
Increased levels of MR-proADM on admission and during hospital stay were independently associated with in-hospital mortality and may allow a better risk stratification, and particularly rule-out of fatal outcome, in COVID-19 patients.
Insights
Midregional pro-adrenomedullin (MR-proADM) levels predict mortality in COVID-19 patients. Higher MR-proADM on admission and during hospitalization indicates increased risk, aiding in risk stratification and ruling out fatal outcomes.
Area of Science:
- Biochemistry and Molecular Biology
- Infectious Diseases
- Critical Care Medicine
Background:
- Midregional pro-adrenomedullin (MR-proADM) is a vasoactive peptide crucial for endothelial stability during infections.
- MR-proADM is established for risk stratification in sepsis but lacks data for COVID-19 prediction.
Purpose of the Study:
- To investigate the predictive accuracy of MR-proADM for in-hospital mortality in COVID-19 patients.
- To assess the association between MR-proADM levels and outcomes in severe acute respiratory syndrome coronavirus 2 disease.
Main Methods:
- Adult patients hospitalized with confirmed COVID-19 were consecutively included.
- Logistic regression and discrimination analyses were used to evaluate MR-proADM levels' association with in-hospital mortality.
Main Results:
- MR-proADM levels were significantly higher in non-survivors (1.3 nmol/L) compared to survivors (0.8 nmol/L).
- An increase of 1 nmol/L in admission MR-proADM was independently associated with a >5-fold increase in mortality (aOR 5.5).
- An MR-proADM threshold of 0.93 nmol/L demonstrated high prognostic accuracy (93% sensitivity, 97% NPV).
Conclusions:
- Elevated MR-proADM levels on admission and during hospitalization are independently linked to increased in-hospital mortality in COVID-19 patients.
- MR-proADM can enhance risk stratification and aid in ruling out fatal outcomes for COVID-19 patients.
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