The vasoactive peptide MR-pro-adrenomedullin in COVID-19 patients: an observational study
The vasoactive peptide MR-pro-adrenomedullin in COVID-19 patients: an observational study
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.
biomarker, COVID-19, in-hospital mortality, prognostic markers, SARS-CoV-2
995-1004
Gregoriano, Claudia
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Koch, Daniel
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Kutz, Alexander
10599b2d-2007-4220-ba9f-df3454e4d945
Haubitz, Sebastian
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Conen, Anna
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Bernasconi, Luca
d8a4e258-3e9a-45b0-bff3-dd4e7aba0840
Hammerer-Lercher, Angelika
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Saeed, Kordo
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Mueller, Beat
50ac3513-fa7c-43eb-af01-4d8beb37c131
Schuetz, Philipp
ad48627c-d757-419c-bda1-a44b620bdd25
27 April 2021
Gregoriano, Claudia
bf93f5bd-6dff-4906-8b2f-8751d03bb237
Koch, Daniel
476659ae-269d-4055-b56a-2bb2b9c4d6ce
Kutz, Alexander
10599b2d-2007-4220-ba9f-df3454e4d945
Haubitz, Sebastian
de2ef4ab-0ebd-449f-a00a-dcf92ba3585f
Conen, Anna
d64e79b0-0197-4c9b-8cd1-013b6b424f9c
Bernasconi, Luca
d8a4e258-3e9a-45b0-bff3-dd4e7aba0840
Hammerer-Lercher, Angelika
8b288d65-9379-4550-8a52-8809ef29722d
Saeed, Kordo
87cb67e5-71e8-4759-bf23-2ea00ebd8b39
Mueller, Beat
50ac3513-fa7c-43eb-af01-4d8beb37c131
Schuetz, Philipp
ad48627c-d757-419c-bda1-a44b620bdd25
Gregoriano, Claudia, Koch, Daniel, Kutz, Alexander, Haubitz, Sebastian, Conen, Anna, Bernasconi, Luca, Hammerer-Lercher, Angelika, Saeed, Kordo, Mueller, Beat and Schuetz, Philipp
(2021)
The vasoactive peptide MR-pro-adrenomedullin in COVID-19 patients: an observational study.
Clinical Chemistry and Laboratory Medicine, 59 (5), .
(doi:10.1515/cclm-2020-1295).
Abstract
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.
Text
10.1515_cclm-2020-1295
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Accepted/In Press date: 15 December 2020
e-pub ahead of print date: 8 January 2021
Published date: 27 April 2021
Additional Information:
Funding Information:
Research funding: Costs for biomarker measurement (reagents) were externally sponsored by ThermoFisher Scientific, BRAHMS, Henningsdorf (Germany). This study was funded by Research Council KSA (Kantonsspital Aarau). The funding agency have no bearing on the study design, data collection and analysis or writing of the manuscript.
Keywords:
biomarker, COVID-19, in-hospital mortality, prognostic markers, SARS-CoV-2
Identifiers
Local EPrints ID: 485387
URI: http://eprints.soton.ac.uk/id/eprint/485387
ISSN: 1434-6621
PURE UUID: fe3b3b14-5b45-4e56-adbf-ca2f1b15c582
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Date deposited: 05 Dec 2023 17:46
Last modified: 18 Mar 2024 03:52
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Contributors
Author:
Claudia Gregoriano
Author:
Daniel Koch
Author:
Alexander Kutz
Author:
Sebastian Haubitz
Author:
Anna Conen
Author:
Luca Bernasconi
Author:
Angelika Hammerer-Lercher
Author:
Kordo Saeed
Author:
Beat Mueller
Author:
Philipp Schuetz
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