Abstract
Objectives: Thromboinflammation, resulting from a complex interaction between thrombocytopathy, coagulopathy, and endotheliopathy, contributes to increased mortality in COVID-19 patients. MR-proADM, as a surrogate of adrenomedullin system disruption, leading to endothelial damage, has been reported as a promising biomarker for short-term prognosis. We evaluated the role of MR-proADM in the mid-term mortality in COVID-19 patients.
Methods: A prospective, observational study enrolling COVID-19 patients from August to October 2020. A blood sample for laboratory test analysis was drawn on arrival in the emergency department. The primary endpoint was 90-day mortality. The area under the curve (AUC) and Cox regression analyses were used to assess discriminatory ability and association with the endpoint.
Results: A total of 359 patients were enrolled, and the 90-day mortality rate was 8.9%. ROC AUC for MR-proADM predicting 90-day mortality was 0.832. An optimal cutoff of 0.80 nmol/L showed a sensitivity of 96.9% and a specificity of 58.4%, with a negative predictive value of 99.5%. Circulating MR-proADM levels (inverse transformed), after adjusting by a propensity score including eleven potential confounders, were an independent predictor of 90-day mortality (HR: 0.162 [95% CI: 0.043-0.480]) CONCLUSIONS: Our data confirm that MR-proADM has a role in the mid-term prognosis of COVID-19 patients and might assist physicians with risk stratification.
Keywords: COVID-19; Mid-regional proadrenomedullin; SARS-CoV-2; endotheliopathy; second wave; severity.
【저자키워드】 COVID-19, SARS-CoV-2, endotheliopathy, severity, second wave, mid-regional proadrenomedullin, 【초록키워드】 Biomarker, Mortality, Prognosis, endotheliopathy, severity, endothelial damage, observational study, emergency department, Predictive value, Laboratory, Coagulopathy, adrenomedullin, risk stratification, sensitivity, specificity, Patient, second wave, mortality rate, Thromboinflammation, COVID-19 patients, association, MR-proADM, Propensity score, primary endpoint, Analysis, Cox regression, COVID-19 patient, Negative predictive value, AUC, Laboratory test, Endpoint, blood sample, confounders, increased mortality, Cutoff, ROC AUC, physician, surrogate, complex interaction, thrombocytopathy, independent, enrolled, resulting, reported, evaluated, were used, contribute, assist, 【제목키워드】 Mortality, Endothelial dysfunction, COVID-19 patient,