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MR-proADM as prognostic factor of outcome in COVID-19 patients
Emanuela Sozio1, Carlo Tascini2, Martina Fabris3
1U.O. Malattie Infettive, Dipartimento Di Medicina Dell'Università Di Udine, Università Di Udine E Azienda Sanitaria Universitaria Integrata Di Udine, Via Pozzuolo, 330, 33100, Udine, Italy.
Abstract:
Mid Regional pro-ADM (MR-proADM) is a promising novel biomarker in the evaluation of deteriorating patients and an emergent prognosis factor in patients with sepsis, septic shock and organ failure. It can be induced by bacteria, fungi or viruses. We hypothesized that the assessment of MR-proADM, with or without other inflammatory cytokines, as part of a clinical assessment of COVID-19 patients at hospital admission, may assist in identifying those likely to develop severe disease. A pragmatic retrospective analysis was performed on a complete data set from 111 patients admitted to Udine University Hospital, in northern Italy, from 25th March to 15th May 2020, affected by SARS-CoV-2 pneumonia. Clinical scoring systems (SOFA score, WHO disease severity class, SIMEU clinical phenotype), cytokines (IL-6, IL-1b, IL-8, TNF-α), and MR-proADM were measured. Demographic, clinical and outcome data were collected for analysis. At multivariate analysis, high MR-proADM levels were significantly associated with negative outcome (death or orotracheal intubation, IOT), with an odds ratio of 4.284 [1.893-11.413], together with increased neutrophil count (OR = 1.029 [1.011-1.049]) and WHO disease severity class (OR = 7.632 [5.871-19.496]). AUROC analysis showed a good discriminative performance of MR-proADM (AUROC: 0.849 [95% Cl 0.771-0.730]; p < 0.0001). The optimal value of MR-proADM to discriminate combined event of death or IOT is 0.895 nmol/l, with a sensitivity of 0.857 [95% Cl 0.728-0.987] and a specificity of 0.687 [95% Cl 0.587-0.787]. This study shows an association between MR-proADM levels and the severity of COVID-19. The assessment of MR-proADM combined with clinical scoring systems could be of great value in triaging, evaluating possible escalation of therapies, and admission avoidance or inclusion into trials. Larger prospective and controlled studies are needed to confirm these findings.
Insights
Mid-regional pro-adrenomedullin (MR-proADM) can predict severe COVID-19 outcomes. High MR-proADM levels at admission are linked to a higher risk of death or intubation, aiding clinical decision-making for SARS-CoV-2 patients.
Area of Science:
- Biomarker Discovery and Validation
- Infectious Diseases and Epidemiology
- Critical Care Medicine
Background:
- Mid-regional pro-adrenomedullin (MR-proADM) is an emerging prognostic biomarker for sepsis and organ failure.
- COVID-19 presents a spectrum of disease severity, necessitating accurate prognostic tools for patient management.
- The role of MR-proADM in predicting severe outcomes in SARS-CoV-2 pneumonia requires further investigation.
Purpose of the Study:
- To investigate the association between MR-proADM levels at hospital admission and the severity of COVID-19.
- To evaluate the potential of MR-proADM, alone or with inflammatory cytokines, to identify patients at risk of severe disease.
- To assess the predictive performance of MR-proADM for negative outcomes such as death or orotracheal intubation.
Main Methods:
- A retrospective analysis of 111 COVID-19 patients admitted to Udine University Hospital.
- Measurement of MR-proADM, inflammatory cytokines (IL-6, IL-1b, IL-8, TNF-α), and clinical scoring systems (SOFA, WHO, SIMEU).
- Multivariate analysis and Area Under the Receiver Operating Characteristic (AUROC) curve analysis to determine predictive value.
Main Results:
- High MR-proADM levels were significantly associated with negative outcomes (death or orotracheal intubation) (OR: 4.284).
- Increased neutrophil count and higher WHO disease severity class also predicted negative outcomes.
- MR-proADM demonstrated good discriminative performance (AUROC: 0.849), with an optimal threshold of 0.895 nmol/l for predicting death or intubation.
Conclusions:
- MR-proADM levels at hospital admission are associated with COVID-19 severity and predict negative outcomes.
- Combining MR-proADM assessment with clinical scoring systems can aid in patient triage and treatment escalation decisions.
- Further prospective studies are warranted to validate these findings and establish MR-proADM in clinical practice for COVID-19 management.
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