Abstract
Background: Biomarkers are used for diagnosis, risk stratification and medical decisions. Copeptin and mid-regional proadrenomedullin (MR-proADM) are markers of stress and endothelial function, respectively, which have been studied in pneumonia, sepsis and septic shock. This study aimed to assess whether copeptin and MR-proADM could predict coronavirus disease 2019 (COVID-19) in-hospital outcomes, that is multi-system complications, length of stay and mortality.
Methods: Copeptin and MR-proADM were assessed at admission in 116 patients hospitalized with COVID-19. Data were retrospectively extracted from an online database. The primary endpoint was in-hospital mortality. The secondary endpoints were in-hospital complications, the composite outcome ‘death, or admission to intensive care unit, or in-hospital complications’, and length of stay. The predictive power was expressed as area under the receiver operator characteristic curve (AUROC).
Results: Copeptin was increased in non-survivors (median 29.7 [interquartile range 13.0-106.2] pmol/L) compared to survivors (10.9 [5.9-25.3] pmol/L, p < 0.01). The AUROC for mortality was 0.71, with a hazard ratio of 3.67 (p < 0.01) for copeptin values > 25.3 pmol/L. MR-proADM differentiated survivors (0.8 [0.6-1.1] nmol/L) from non-survivors (1.5 [1.1-2.8] nmol/L, p < 0.001) and yielded a AUROC of 0.79 and a hazard ratio of 7.02 (p < 0.001) for MR-proADM values > 1.0 nmol/L. Copeptin and MR-proADM predicted sepsis (AUROC 0.95 and 0.96 respectively), acute kidney injury (0.87 and 0.90), the composite outcome (0.69 and 0.75) and length of stay (r = 0.42, p < 0.001, and r = 0.46, p < 0.001).
Conclusions: Admission MR-proADM and copeptin may be implemented for early risk stratification in COVID-19-hospitalized patients to help identify those eligible for closer monitoring and care intensification.
Keywords: COVID-19; biomarkers; copeptin; mid-regional proadrenomedullin; mortality; prognosis.
【저자키워드】 COVID-19, Biomarkers, Mortality, Prognosis., copeptin, mid-regional proadrenomedullin, 【초록키워드】 coronavirus disease, Coronavirus disease 2019, Biomarkers, intensive care, Stress, Prognosis, Pneumonia, intensive care unit, Diagnosis, Sepsis, Acute kidney injury, outcome, database, outcomes, risk stratification, Hospital mortality, Patient, death, Septic shock, complications, Admission, Care, predict, in-hospital mortality, MR-proADM, marker, primary endpoint, endothelial function, In-hospital, interquartile range, Non-survivors, secondary endpoint, Secondary endpoints, hazard ratio, help, AUROC, predictive power, survivor, in-hospital complications, non-survivor, Receiver operator characteristic, predicted, identify, median, expressed, eligible, in-hospital complication, patients hospitalized, was increased, were assessed, with COVID-19, 【제목키워드】 Patient,