Objective To test the effectiveness of mid-regional pro-adrenomedullin (MR-proADM) in comparison to C-reactive protein (CRP), procalcitonin (PCT), D-dimer, lactate dehydrogenase (LDH) in predicting mortality in COVID-19-ICU-patients. Methods All consecutive COVID-19 adult patients admitted between March and June 2020 to the ICU of a referral, university hospital in Northern-Italy were enrolled. MR-proADM and routine laboratory test were measured within 48 hours from ICU admission, on day 3, 7 and 14. Survival curves difference with MR-proADM cut-off set to 1.8 nmol/L were tested using log-rank test. Predictive ability was compared using area under the curve and 95% confidence interval of different receiver-operating characteristics curves. Results 57 patients were enrolled. ICU and overall mortality were 54.4%. At admission, lymphocytopenia was present in 86% of patients; increased D-dimer and CRP levels were found in 84.2% and 87.7% of patients respectively, while PCT values > 0.5 μg/L were observed in 47.4% of patients. MR-proADM, CRP and LDH were significantly different between surviving and non-surviving patients and over time, while PCT, D-dimer and NT-pro-BNP did not show any difference between the groups and over time; lymphocytes were different between surviving and non-surviving patients only. MR-proADM was higher in dying patients (2.65±2.33vs1.18±0.47, p<0.001) and a higher mortality characterized patients with MR-proADM >1.8 nmol/L (p = 0.016). The logistic regression model adjusted for age, gender, cardiovascular disease, diabetes mellitus and PCT values confirmed an odds ratio = 10.3 [95%CI:1.9–53.6] (p = 0.006) for MR-proADM >1.8 nmol/L and = 22.2 [95%CI:1.6–316.9] (p = 0.022) for cardiovascular disease. Overall, MR-proADM had the best predictive ability (AUC = 0.85 [95%CI:0.78–0.90]). Conclusions In COVID-19 ICU-patients, MR-proADM seems to have constantly higher values in non-survivor patients and predict mortality more precisely than other biomarkers. Repeated MR-proADM measurement may support a rapid and effective decision-making. Further studies are needed to better explain the mechanisms responsible of the increase in MR-proADM in COVID-19 patients.
【초록키워드】 Biomarkers, Lymphocytes, Mortality, Diabetes Mellitus, LDH, Gender, C-reactive protein, cardiovascular disease, CRP, D-dimer, procalcitonin, diabetes, lactate dehydrogenase, ICU, Laboratory, lymphocyte, lymphocytopenia, Patient, Effectiveness, ICU admission, Referral, age, group, Admission, patients, predict, mechanism, COVID-19 patients, MR-proADM, Lactate, Odds ratio, AUC, Laboratory test, best, Predictive, Survival curves, 48 hours, dying patients, Support, survival curve, 95% confidence interval, overall mortality, university hospital, COVID-19-ICU-patients, CRP levels, higher mortality characterized patients, log-rank test, logistic regression model, mid-regional pro-adrenomedullin, NT-pro-BNP, surviving and non-surviving patients, CRP level, cut-off, objective, PCT, effective, non-survivor, Result, enrolled, responsible, tested, significantly, characterized, adjusted, increase in, explain, were measured, 48 hour, COVID-19 adult patient, COVID-19 ICU-patients, dying patient, MR-proADM measurement, receiver-operating characteristics curves, 【제목키워드】 COVID-19, Prospective Study, Critically ill, Prognostic marker,