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Prognostic value of proadrenomedullin in patients with COVID-19 pneumonia
Aleksandr A Astapovskii1, Vladimir N Drozdov1, Evgenia V Shikh1
1Department of Clinical Pharmacology and Propedeutics of Internal Diseases, First Moscow State Medical University Named After I.M. Sechenov, Moscow, Russia.
Objective:
The aim of the study was to assess the role of mid-regional proadrenomedullin (MR-proADM) in comparison with routine laboratory tests in patients with COVID-19.
Materials And Methods:
140 hospitalized patients aged 18 and older with COVID-19 pneumonia were included in prospective single-center study. Routine analyses were performed, and MR-proADM level was measured within the first and the third hospital days using Human MR pro-ADM (Mid-regional pro-adrenomedullin) ELISA Kit with a sensitivity of 0.469 pmol/L (immunofluorescence assay). National Early Warning Score (NEWS) was used for primary assessment of the disease severity. According to disease outcome the patients were divided into two groups: discharged patients (n = 110, 78.6%) and deceased patients (n = 30, 21.4%). Results: The groups had no statistically significant difference in sex, comorbidity, body temperature, oxygen saturation level, heart rate, respiratory rate, and C-reactive protein (CRP) level and procalcitonin (PCT). The deceased patients had statistically significant difference in age (median, 76 years; interquartile range, 73.2-78.2 vs. median, 66 years; interquartile range, 62-67; p < 0.0001), NEWS value (median, 5; interquartile range, 3-8 vs. median, 2; interquartile range, 0-6; p <0.05), hospitalization period (median, 17; interquartile range, 7-35 vs. median, 6; interquartile range, 3-14), quantitative CT extent of lung damage > 50% [n = 26 (86.7%) vs. n = 9 (8.2%) p < 0.0001], level of leukocytes (median, 11.4 ×109/L; interquartile range, 6.2-15.5 vs. median, 5.3 ×109/L; interquartile range, 4.7-6.4; p = 0.003), level of neutrophils (median, 80.9%; interquartile range, 73.6-88.6 vs. median, 72.6%; interquartile range, 68.7-76.9; p = 0.027), level of MR-proADM at the first hospital day (median, 828.6 pmol/L; interquartile range, 586.4-1,184.6 vs. median, 492.6 pmol/L; interquartile range, 352.9-712.2; p = 0.02), and level of MR-proADM at the third hospital day (median, 1,855.2 pmol/L; interquartile range, 1,078.4-2,596.5 vs. median, 270.7 pmol/L; interquartile range, 155.06-427.1).
Conclusion:
Mid-regional proadrenomedullin has a higher prognostic value in patients with COVID-19 in comparison with routine inflammatory markers (leukocyte and neutrophils levels, CRP, and PCT) and NEWS.
Insights
Mid-regional proadrenomedullin (MR-proADM) shows greater prognostic value than standard tests for predicting COVID-19 patient outcomes. Higher MR-proADM levels on day three indicate a poorer prognosis, aiding in early risk assessment.
Area of Science:
- Biochemistry
- Clinical Medicine
- Infectious Diseases
Background:
- COVID-19 pneumonia poses a significant threat, necessitating accurate prognostic markers.
- Routine laboratory tests and clinical scores have limitations in predicting severe outcomes.
- Mid-regional proadrenomedullin (MR-proADM) is a biomarker that may offer improved prognostic capabilities.
Purpose of the Study:
- To evaluate the prognostic value of MR-proADM compared to routine laboratory tests and the National Early Warning Score (NEWS) in hospitalized COVID-19 patients.
- To determine if MR-proADM levels can predict disease severity and patient outcomes.
Main Methods:
- A prospective single-center study included 140 hospitalized COVID-19 pneumonia patients.
- MR-proADM levels were measured on hospital days 1 and 3.
- Routine laboratory tests (leukocytes, neutrophils, CRP, PCT) and NEWS were assessed for correlation with outcomes.
Main Results:
- Deceased patients were older and had significantly higher NEWS, leukocyte and neutrophil counts, and MR-proADM levels on both days 1 and 3.
- MR-proADM levels on day 3 were markedly higher in non-survivors (median 1,855.2 pmol/L) compared to survivors (median 270.7 pmol/L).
- MR-proADM demonstrated a higher prognostic value than routine inflammatory markers and NEWS.
Conclusions:
- MR-proADM is a valuable prognostic biomarker in COVID-19 patients.
- Elevated MR-proADM levels, particularly on the third hospital day, are associated with increased mortality risk.
- MR-proADM offers superior prognostic information compared to conventional markers for COVID-19 severity.
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