Critical and non-critical coronavirus disease 2019 patients: which is the most predictive biomarker for disease severity and outcome?: A multicentre prospective cohort study comparing mid-regional pro-adrenomedullin, inflammatory and immunological patterns.
Eur J Anaesthesiol Intensive Care
From the Department of Surgical Sciences, University of Turin (GM, EB, GS, VF, lB), Department of Anaesthesia, Critical Care and Emergency - Città Della Salute e Della Scienza Hospital, Turin (GM, GS, VF, LB), Unit of Infectious Diseases, ASO SS. Antonio e Biagio e Cesare Arrigo, Alessandria (CB, CS), Department of Emergency, Anesthesia and Critical Care Medicine (ADS, ER), Department of Emergency Medicine (MP), Department of Internal Medicine, Michele e Pietro Ferrero Hospital, Verduno (FP), Clinical Biochemistry Laboratory, Città Della Salute e Della Scienza Hospital, Torino (FR, GM), Clinical Biochemistry Laboratory, ASO SS. Antonio e Biagio e Cesare Arrigo, Alessandria (TC) and Department of Medical Sciences, University of Turin, Torino, Italy (GM).
Published: December 2023
Background: Severe acute respiratory syndrome-coronavirus-2 in coronavirus disease 2019 (COVID-19) patients leads to a wide range of clinical manifestations. The evaluation of mid-regional pro-adrenomedullin (MR-proADM) as a prognostic biomarker in noncritical wards (NON-ICU) and intensive care units (ICU), may have a potential in predicting disease severity and outcomes.
Objective: To assess the difference in the prognostic power of MR-proADM in NON-ICU wards and in ICUs in a prospective multicentre cohort study.
Design: From January to July 2021, all adult COVID-19 patients requiring admission for more than 48 h.
Setting: One primary centre and two secondary centre hospitals.
Patients: One hundred and twenty-three ICU and 77 NON-ICU patients.
Intervention: MR-proADM, lymphocyte subpopulations and immunoglobulins were measured within 48 h and on days 3 and 7. A Log-rank test was used to compare survival curves, using a MR-proADM cut-off value of 1.5 nmol l. The predictive ability for mortality was compared using the area under the curve and 95% confidence interval (CI) of different receiver-operating characteristic curves.
Main Outcome Measures: The first 48 h MR-proADM values were significantly higher in the ICU group (median value 1.10 [IQR, 0.80 to 1.73] pg ml vs. 0.90 [0.70 to 1.20] pg ml, = 0.020), and statistically significant changes were observed over time for MR-proADM, CD3+, CD4+ and CD56+. In univariate analysis, MR-proADM was the only biomarker that significantly predicted mortality ( = 0.006). The logistic regression model showed an odds ratio for mortality equal to 1.83 (95% CI, 1.08 to 3.37) = 0.035 for MR-proADM, 1.37 (1.15 to 1.68) = 0.001 for MuLBSTA and 1.11 (1.05 to 1.18) less than 0.001 for SAPS II.
Conclusion: MR-proADM admission values and trends over time appear to be a suitable marker of illness severity and a patient's risk of mortality in both ICU and NON-ICU settings. Lymphocyte subpopulation dysfunction seems to play a role in defining the severity of COVID-19 but is limited to ICU setting.
Trial Registration: on clinicaltrials.gov, NCT04873388 registered on March 2020.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798374 | PMC |
| http://dx.doi.org/10.1097/EA9.0000000000000039 | DOI Listing |
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