Mid-regional proadrenomedullin (MR-proADM), C-reactive protein (CRP) and other biomarkers in the early identification of disease progression in patients with COVID-19 in the acute NHS setting
Mid-regional proadrenomedullin (MR-proADM), C-reactive protein (CRP) and other biomarkers in the early identification of disease progression in patients with COVID-19 in the acute NHS setting
AIMS: There is a lack of biomarkers validated for assessing clinical deterioration in patients with COVID-19 on presentation to secondary or tertiary care. This evaluation looked at the potential clinical application of C reactive protein (CRP), procalcitonin, mid-regional proadrenomedullin (MR-proADM) and white cell count to support prediction of clinical outcomes.
METHODS: 135 patients presenting to Hampshire Hospitals NHS Foundation Trust between April and June 2020 confirmed to have COVID-19 via reverse-transcription-qPCR were included. Biomarkers from within 24 hours of presentation were used to predict disease progression by Cox regression and area under the receiver operating characteristic curves. The endpoints assessed were 30-day all-cause mortality, intubation and ventilation, critical care admission and non-invasive ventilation (NIV) use.
RESULTS: Elevated MR-proADM was shown to have the greatest ability to predict 30-day mortality adjusting for age, cardiovascular disease, renal disease and neurological disease. A significant association was also noted between raised MR-proADM and CRP concentrations and the requirement for critical care admission and NIV.
CONCLUSIONS: The measurement of MR-proADM and CRP in patients with confirmed COVID-19 infection on admission shows significant potential to support clinicians in identifying those at increased risk of disease progression and need for higher level care, subsequently enabling prompt escalation in clinical interventions.
COVID-19, biochemistry, blood proteins, infections, microbiology
Moore, Nathan
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Williams, Rebecca
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Mori, Matilde
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Bertolusso, Beatrice
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Vernet, Gabrielle
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Lynch, Jessica
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Philipson, Pete
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Ledgerwood, Thomas
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Kidd, Stephen P
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Thomas, Claire
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Garcia-Arias, Veronica
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Young, Michelle
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Saeed, Kordo
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Gordon, Kirsty
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Cortes, Nicholas
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7 January 2022
Moore, Nathan
685fa518-20ce-4c8b-8cbb-bfb929a30da7
Williams, Rebecca
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Mori, Matilde
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Bertolusso, Beatrice
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Vernet, Gabrielle
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Lynch, Jessica
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Philipson, Pete
dd28111a-fc1a-4673-b9bf-a29f38f8f6ee
Ledgerwood, Thomas
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Kidd, Stephen P
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Thomas, Claire
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Garcia-Arias, Veronica
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Young, Michelle
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Saeed, Kordo
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Gordon, Kirsty
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Cortes, Nicholas
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Moore, Nathan, Williams, Rebecca, Mori, Matilde, Bertolusso, Beatrice, Vernet, Gabrielle, Lynch, Jessica, Philipson, Pete, Ledgerwood, Thomas, Kidd, Stephen P, Thomas, Claire, Garcia-Arias, Veronica, Young, Michelle, Saeed, Kordo, Gordon, Kirsty and Cortes, Nicholas
(2022)
Mid-regional proadrenomedullin (MR-proADM), C-reactive protein (CRP) and other biomarkers in the early identification of disease progression in patients with COVID-19 in the acute NHS setting.
Journal of Clinical Pathology, [jclinpath-2021-207750].
(doi:10.1136/jclinpath-2021-207750).
Abstract
AIMS: There is a lack of biomarkers validated for assessing clinical deterioration in patients with COVID-19 on presentation to secondary or tertiary care. This evaluation looked at the potential clinical application of C reactive protein (CRP), procalcitonin, mid-regional proadrenomedullin (MR-proADM) and white cell count to support prediction of clinical outcomes.
METHODS: 135 patients presenting to Hampshire Hospitals NHS Foundation Trust between April and June 2020 confirmed to have COVID-19 via reverse-transcription-qPCR were included. Biomarkers from within 24 hours of presentation were used to predict disease progression by Cox regression and area under the receiver operating characteristic curves. The endpoints assessed were 30-day all-cause mortality, intubation and ventilation, critical care admission and non-invasive ventilation (NIV) use.
RESULTS: Elevated MR-proADM was shown to have the greatest ability to predict 30-day mortality adjusting for age, cardiovascular disease, renal disease and neurological disease. A significant association was also noted between raised MR-proADM and CRP concentrations and the requirement for critical care admission and NIV.
CONCLUSIONS: The measurement of MR-proADM and CRP in patients with confirmed COVID-19 infection on admission shows significant potential to support clinicians in identifying those at increased risk of disease progression and need for higher level care, subsequently enabling prompt escalation in clinical interventions.
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Accepted/In Press date: 2022
e-pub ahead of print date: 7 January 2022
Published date: 7 January 2022
Additional Information:
Funding Information:
PP received payment from Thermo Fisher and KS has received research grants from Pfizer and Thermo Fisher. However, neither the payment for PP nor the research grants for KS had any role in study conception, the collection, management, analysis or interpretation of the data, in preparation, review or approval of the manuscript or in the decision to submit the manuscript for publication.
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© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords:
COVID-19, biochemistry, blood proteins, infections, microbiology
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Local EPrints ID: 454276
URI: http://eprints.soton.ac.uk/id/eprint/454276
ISSN: 0021-9746
PURE UUID: cd1df189-85e1-48c1-aa0e-9b064b903319
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Date deposited: 04 Feb 2022 17:44
Last modified: 17 Mar 2024 03:56
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Contributors
Author:
Nathan Moore
Author:
Rebecca Williams
Author:
Matilde Mori
Author:
Beatrice Bertolusso
Author:
Gabrielle Vernet
Author:
Jessica Lynch
Author:
Pete Philipson
Author:
Thomas Ledgerwood
Author:
Stephen P Kidd
Author:
Claire Thomas
Author:
Veronica Garcia-Arias
Author:
Michelle Young
Author:
Kordo Saeed
Author:
Kirsty Gordon
Author:
Nicholas Cortes
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