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Identification of COVID-19 patients at risk of hospital admission and mortality: a European multicentre retrospective analysis of mid-regional pro-adrenomedullin

Identification of COVID-19 patients at risk of hospital admission and mortality: a European multicentre retrospective analysis of mid-regional pro-adrenomedullin
Identification of COVID-19 patients at risk of hospital admission and mortality: a European multicentre retrospective analysis of mid-regional pro-adrenomedullin
Background: Mid-Regional pro-Adrenomedullin (MR-proADM) is an inflammatory biomarker that improves the prognostic assessment of patients with sepsis, septic shock and organ failure. Previous studies of MR-proADM have primarily focussed on bacterial infections. A limited number of small and monocentric studies have examined MR-proADM as a prognostic factor in patients infected with SARS-CoV-2, however there is need for multicenter validation. An evaluation of its utility in predicting need for hospitalisation in viral infections was also performed. Methods: An observational retrospective analysis of 1861 patients, with SARS-CoV-2 confirmed by RT-qPCR, from 10 hospitals across Europe was performed. Biomarkers, taken upon presentation to Emergency Departments (ED), clinical scores, patient demographics and outcomes were collected. Multiclass random forest classifier models were generated as well as calculation of area under the curve analysis. The primary endpoint was hospital admission with and without death. Results: Patients suitable for safe discharge from Emergency Departments could be identified through an MR-proADM value of ≤ 1.02 nmol/L in combination with a CRP (C-Reactive Protein) of ≤ 20.2 mg/L and age ≤ 64, or in combination with a SOFA (Sequential Organ Failure Assessment) score < 2 if MR-proADM was ≤ 0.83 nmol/L regardless of age. Those at an increased risk of mortality could be identified upon presentation to secondary care with an MR-proADM value of > 0.85 nmol/L, in combination with a SOFA score ≥ 2 and LDH > 720 U/L, or in combination with a CRP > 29.26 mg/L and age ≤ 64, when MR-proADM was > 1.02 nmol/L. Conclusions: This international study suggests that for patients presenting to the ED with confirmed SARS-CoV-2 infection, MR-proADM in combination with age and CRP or with the patient’s SOFA score could identify patients at low risk where outpatient treatment may be safe.
Emergency department, Hospital admission, Mortality, MR-proADM, SARS-CoV-2
1465-9921
Sozio, Emanuela
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Moore, Nathan A.
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Fabris, Martina
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Ripoli, Andrea
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Rumbolo, Francesca
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Minieri, Marilena
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Boverio, Riccardo
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Rodríguez Mulero, María Dolores
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Lainez-Martinez, Sara
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Martínez Martínez, Mónica
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Calvo, Dolores
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Gregoriano, Claudia
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Williams, Rebecca
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Brazzi, Luca
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Terrinoni, Alessandro
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Callegari, Tiziana
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Hernández Olivo, Marta
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Esteban-Torrella, Patricia
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Calcerrada, Ismael
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Bernasconi, Luca
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Kidd, Stephen P.
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Sbrana, Francesco
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Miguens, Iria
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Gordon, Kirsty
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Visentini, Daniela
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Legramante, Jacopo M.
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Bassi, Flavio
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Cortes, Nicholas
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Montrucchio, Giorgia
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Di Lecce, Vito N.
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Lauritano, Ernesto C.
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García de Guadiana-Romualdo, Luis
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González del Castillo, Juan
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Bernal-Morell, Enrique
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Andaluz-Ojeda, David
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Schuetz, Philipp
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Curcio, Francesco
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Tascini, Carlo
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Saeed, Kordo
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et al.
Sozio, Emanuela
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Moore, Nathan A.
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Fabris, Martina
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Ripoli, Andrea
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Rumbolo, Francesca
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Minieri, Marilena
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Boverio, Riccardo
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Rodríguez Mulero, María Dolores
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Lainez-Martinez, Sara
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Martínez Martínez, Mónica
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Calvo, Dolores
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Gregoriano, Claudia
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Williams, Rebecca
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Brazzi, Luca
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Terrinoni, Alessandro
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Callegari, Tiziana
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Hernández Olivo, Marta
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Esteban-Torrella, Patricia
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Calcerrada, Ismael
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Bernasconi, Luca
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Kidd, Stephen P.
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Sbrana, Francesco
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Miguens, Iria
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Gordon, Kirsty
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Visentini, Daniela
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Legramante, Jacopo M.
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Bassi, Flavio
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Cortes, Nicholas
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Montrucchio, Giorgia
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Di Lecce, Vito N.
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Lauritano, Ernesto C.
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García de Guadiana-Romualdo, Luis
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González del Castillo, Juan
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Bernal-Morell, Enrique
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Andaluz-Ojeda, David
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Schuetz, Philipp
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Curcio, Francesco
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Tascini, Carlo
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Saeed, Kordo
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Sozio, Emanuela, Moore, Nathan A., Fabris, Martina, Ripoli, Andrea and Saeed, Kordo , et al. (2022) Identification of COVID-19 patients at risk of hospital admission and mortality: a European multicentre retrospective analysis of mid-regional pro-adrenomedullin. Respiratory Research, 23 (1), [221]. (doi:10.1186/s12931-022-02151-1).

Record type: Article

Abstract

Background: Mid-Regional pro-Adrenomedullin (MR-proADM) is an inflammatory biomarker that improves the prognostic assessment of patients with sepsis, septic shock and organ failure. Previous studies of MR-proADM have primarily focussed on bacterial infections. A limited number of small and monocentric studies have examined MR-proADM as a prognostic factor in patients infected with SARS-CoV-2, however there is need for multicenter validation. An evaluation of its utility in predicting need for hospitalisation in viral infections was also performed. Methods: An observational retrospective analysis of 1861 patients, with SARS-CoV-2 confirmed by RT-qPCR, from 10 hospitals across Europe was performed. Biomarkers, taken upon presentation to Emergency Departments (ED), clinical scores, patient demographics and outcomes were collected. Multiclass random forest classifier models were generated as well as calculation of area under the curve analysis. The primary endpoint was hospital admission with and without death. Results: Patients suitable for safe discharge from Emergency Departments could be identified through an MR-proADM value of ≤ 1.02 nmol/L in combination with a CRP (C-Reactive Protein) of ≤ 20.2 mg/L and age ≤ 64, or in combination with a SOFA (Sequential Organ Failure Assessment) score < 2 if MR-proADM was ≤ 0.83 nmol/L regardless of age. Those at an increased risk of mortality could be identified upon presentation to secondary care with an MR-proADM value of > 0.85 nmol/L, in combination with a SOFA score ≥ 2 and LDH > 720 U/L, or in combination with a CRP > 29.26 mg/L and age ≤ 64, when MR-proADM was > 1.02 nmol/L. Conclusions: This international study suggests that for patients presenting to the ED with confirmed SARS-CoV-2 infection, MR-proADM in combination with age and CRP or with the patient’s SOFA score could identify patients at low risk where outpatient treatment may be safe.

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More information

Published date: 28 August 2022
Additional Information: Funding Information: This research has been partially funded by Universidad Católica San Antonio de Murcia (UCAM) (reference: PMAFI-COVID19/04) and Gerencia Regional de Salud de Castilla y León, Spain, under grant number GRS COVID 108/A/20. Funding Information: Thermofisher provided reagents for measurement of MR-proADM free of charge to some sites involved. KS has received research grants from Pfizer and Thermofisher. CT has received funds for speaking at symposia organized on behalf of Novartis, Merck, Thermofisher, Angelini, Biomerieux, Basilea, Correvio, Zambon, Hikma and Astellas. LB has received founds for speaking at symposia organized with the non-conditioning contribution of MSD, BD, Gilead, Ambu, Biotest, Medtronic and to take part to advisory boards organized by Ambu, Janssen, Gilead. FR has received funds for speaking at symposia organized on behalf of Thermofisher. GM has received funds for speaking at symposia organized on behalf of Thermofisher, Gilead, Pfizer, Ambu. The institution of PS has received research support from Thermofisher, bioMerieux, Nestle and Abbott. However, these had no role in study conception or design, the collection, management, analysis, or interpretation of the data, in the preparation, review, or approval of the manuscript, or in the decision to submit the manuscript for publication. There are no non-financial interests. Other authors have no conflicts of interest. Funding Information: We would like to thank all staff (medical laboratory assistants, biomedical scientists, clinical scientists, physicians, health care assistants, nurses) in any way involved in the management and care of patients during this pandemic. Particular thanks to: Fabio Del Ben, Martina Comand, Agnese Zanus-Fortes, Fabiana Dallai, Denise D’Elia, Eleonora Vania, Angela Acquasanta, Monica Gemignani, University of Udine, 33100 Udine, Italy Matilde Mori, Faculty of Medicine, University of Southampton, UK; Gabrielle Vernet, Thomas Ledgerwood, Claire Thomas, and Veronica Garcia-Arias, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK; Michelle Young, Whittington Hospital, London, UK. Davide Lombardo, Alice Giaccone, Eleonora Balzani and Giulio Mengozzi, Città della Salute e della Scienza Hospital, University of Turin, 10126 Torino, Italy; All the staff of the intensive care unit (AR1-CAR) at Città della Salute e della Scienza Hospital, University of Turin, 10126 Torino, Italy María Galindo Martínez, Critical Care Unit, Hospital Universitario Santa Lucía, Cartagena, Spain; Valerio Campos Rodríguez, Internal Medicine Department, Hospital Universitario Santa Lucía, Cartagena, Spain; María Salomé Ros Braquehais, Pneumology Department, Hospital Universitario Santa Lucía, Cartagena, Spain; Verónica Ramos Arenas, Laboratory Medicine Department, Hospital Universitario Santa Lucía, Cartagena, Spain; Andrés Conesa Hernández, Emergency Department, Hospital Universitario Santa Lucía, Cartagena, Spain; Luciano Consuegra-Sánchez, Cardiology Department, Hospital Universitario Santa Lucía, Cartagena, Spain. María José Alcaraz García, Antonia Alcaraz, Carlos Báguena Perez-Crespo and Cristina Tomás Jiménez, Infectious Disease Unit, Hospital Universitario Reina Sofía, Murcia, Spain; Natalia Sancho-Rodríguez, Laboratory Medicine Department, Hospital Universitario Reina Sofía, Murcia, Spain; Pascual Piñera-Salmerón, Emergency Department, Hospital Universitario Reina Sofía, Murcia, Spain. Cristina Jimenez Bolado, Hilda Fernández Ovalle, Eugenio Azpeleta, Emergency Department, Hospital Clínico Universitario, Valladolid, Spain; Leonor Nogales Martín, Intensive Care Department, Hospital Clínico Universitario, Valladolid, Spain; Wysalli Trapiello Fernández, Medicine Laboratory Department, Hospital Clínico Universitario de Valladolid. Maria Stella Lia, Loreta D’Amico, Annarita Cococcia, Unit of Laboratory Medicine, Tor Vergata University Hospital, Rome, Italy; Sofia Gosti, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy. Publisher Copyright: © 2022, The Author(s).
Keywords: Emergency department, Hospital admission, Mortality, MR-proADM, SARS-CoV-2

Identifiers

Local EPrints ID: 474794
URI: http://eprints.soton.ac.uk/id/eprint/474794
ISSN: 1465-9921
PURE UUID: 3478d743-d005-4f06-9598-9ec955387014
ORCID for Kordo Saeed: ORCID iD orcid.org/0000-0003-0123-0302

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Date deposited: 02 Mar 2023 17:49
Last modified: 18 Mar 2024 03:52

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Contributors

Author: Emanuela Sozio
Author: Nathan A. Moore
Author: Martina Fabris
Author: Andrea Ripoli
Author: Francesca Rumbolo
Author: Marilena Minieri
Author: Riccardo Boverio
Author: María Dolores Rodríguez Mulero
Author: Sara Lainez-Martinez
Author: Mónica Martínez Martínez
Author: Dolores Calvo
Author: Claudia Gregoriano
Author: Rebecca Williams
Author: Luca Brazzi
Author: Alessandro Terrinoni
Author: Tiziana Callegari
Author: Marta Hernández Olivo
Author: Patricia Esteban-Torrella
Author: Ismael Calcerrada
Author: Luca Bernasconi
Author: Stephen P. Kidd
Author: Francesco Sbrana
Author: Iria Miguens
Author: Kirsty Gordon
Author: Daniela Visentini
Author: Jacopo M. Legramante
Author: Flavio Bassi
Author: Nicholas Cortes
Author: Giorgia Montrucchio
Author: Vito N. Di Lecce
Author: Ernesto C. Lauritano
Author: Luis García de Guadiana-Romualdo
Author: Juan González del Castillo
Author: Enrique Bernal-Morell
Author: David Andaluz-Ojeda
Author: Philipp Schuetz
Author: Francesco Curcio
Author: Carlo Tascini
Author: Kordo Saeed ORCID iD
Corporate Author: et al.

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