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

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. 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. 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. 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. © 2022. The Author(s).

Citation

Emanuela Sozio, Nathan A Moore, Martina Fabris, Andrea Ripoli, Francesca Rumbolo, Marilena Minieri, Riccardo Boverio, María Dolores Rodríguez Mulero, Sara Lainez-Martinez, Mónica Martínez Martínez, Dolores Calvo, Claudia Gregoriano, Rebecca Williams, Luca Brazzi, Alessandro Terrinoni, Tiziana Callegari, Marta Hernández Olivo, Patricia Esteban-Torrella, Ismael Calcerrada, Luca Bernasconi, Stephen P Kidd, Francesco Sbrana, Iria Miguens, Kirsty Gordon, Daniela Visentini, Jacopo M Legramante, Flavio Bassi, Nicholas Cortes, Giorgia Montrucchio, Vito N Di Lecce, Ernesto C Lauritano, Luis García de Guadiana-Romualdo, Juan González Del Castillo, Enrique Bernal-Morell, David Andaluz-Ojeda, Philipp Schuetz, Francesco Curcio, Carlo Tascini, Kordo Saeed. Identification of COVID-19 patients at risk of hospital admission and mortality: a European multicentre retrospective analysis of mid-regional pro-adrenomedullin. Respiratory research. 2022 Aug 28;23(1):221

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PMID: 36031619

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