Identification of COVID-19 patients at risk of hospital admission and mortality: a European multicentre retrospective analysis of mid-regional pro-adrenomedullin
Abstract Background 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 m...
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| Format: | Article |
| Language: | English |
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BMC
2022-08-01
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| Series: | Respiratory Research |
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| Online Access: | https://doi.org/10.1186/s12931-022-02151-1 |
| _version_ | 1811188905989373952 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Emanuela Sozio |
| collection | DOAJ |
| description | Abstract Background 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. Methods 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. Results 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. Conclusions 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. |
| first_indexed | 2024-04-11T14:26:05Z |
| format | Article |
| id | doaj.art-f5832d2b581a4a169f76c74dbc7a4499 |
| institution | Directory Open Access Journal |
| issn | 1465-993X |
| language | English |
| last_indexed | 2024-04-11T14:26:05Z |
| publishDate | 2022-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Respiratory Research |
| spelling | doaj.art-f5832d2b581a4a169f76c74dbc7a44992022-12-22T04:18:52ZengBMCRespiratory Research1465-993X2022-08-0123111210.1186/s12931-022-02151-1Identification of COVID-19 patients at risk of hospital admission and mortality: a European multicentre retrospective analysis of mid-regional pro-adrenomedullinEmanuela Sozio0Nathan A. Moore1Martina Fabris2Andrea Ripoli3Francesca Rumbolo4Marilena Minieri5Riccardo Boverio6María Dolores Rodríguez Mulero7Sara Lainez-Martinez8Mónica Martínez Martínez9Dolores Calvo10Claudia Gregoriano11Rebecca Williams12Luca Brazzi13Alessandro Terrinoni14Tiziana Callegari15Marta Hernández Olivo16Patricia Esteban-Torrella17Ismael Calcerrada18Luca Bernasconi19Stephen P. Kidd20Francesco Sbrana21Iria Miguens22Kirsty Gordon23Daniela Visentini24Jacopo M. Legramante25Flavio Bassi26Nicholas Cortes27Giorgia Montrucchio28Vito N. Di Lecce29Ernesto C. Lauritano30Luis García de Guadiana-Romualdo31Juan González del Castillo32Enrique Bernal-Morell33David Andaluz-Ojeda34Philipp Schuetz35Francesco Curcio36Carlo Tascini37Kordo Saeed38Infectious Disease Unit, Azienda Sanitaria Universitaria Integrata di Udine (ASU FC)Department of Microbiology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation TrustInstitute of Clinical Pathology, Azienda Sanitaria Universitaria Integrata di Udine (ASU FC)Fondazione Toscana “Gabriele Monasterio”Clinical Biochemistry Laboratory, Città Della Salute e della Scienza Hospital, University of TurinDepartment of Experimental Medicine, University of Rome Tor VergataEmergency Medicine, Azienda Ospedaliera Nazionale Santi Antonio e Biagio e Cesare ArrigoCritical Care Unit, Hospital Universitario Santa LucíaEmergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San CarlosInfectious Disease Unit, Hospital Universitario Reina SofíaLaboratory Medicine Department, Hospital Clínico UniversitarioMedical University Department of Internal Medicine, Cantonal Hospital AarauDepartment of Microbiology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation TrustDepartment of Surgical Sciences, University of TurinDepartment of Experimental Medicine, University of Rome Tor VergataClinical Pathology Laboratory, Azienda Ospedaliera Nazionale Santi Antonio e Biagio e Cesare ArrigoPneumology Department, Hospital Universitario Santa LucíaLaboratory Medicine Department, Hospital Universitario Reina SofíaPrimary Care Medina del Campo Urbano AreaInstitute of Laboratory Medicine, Cantonal Hospital AarauDepartment of Microbiology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation TrustFondazione Toscana “Gabriele Monasterio”Emergency Service, University Hospital Gregorio Marañón and “Gregorio Marañón” Health Research Institute (IISGM)Department of Biochemistry, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation TrustInstitute of Clinical Pathology, Azienda Sanitaria Universitaria Integrata di Udine (ASU FC)Department of Systems Medicine, University of Rome Tor VergataDepartment of Anesthesia and Intensive Care Medicine, Azienda Sanitaria Universitaria Integrata di Udine (ASU FC)Department of Microbiology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation TrustDepartment of Surgical Sciences, University of TurinEmergency Department, Tor Vergata University HospitalEmergency Medicine, Azienda Ospedaliera Nazionale Santi Antonio e Biagio e Cesare ArrigoLaboratory Medicine Department, Hospital Universitario Santa LucíaEmergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San CarlosInfectious Disease Unit, Hospital Universitario Reina SofíaDepartment of Intensive Care, Hospital Universitario HM SanchinarroMedical University Department of Internal Medicine, Cantonal Hospital AarauInstitute of Clinical Pathology, Azienda Sanitaria Universitaria Integrata di Udine (ASU FC)Infectious Disease Unit, Azienda Sanitaria Universitaria Integrata di Udine (ASU FC)Faculty of Medicine, University of SouthamptonAbstract Background 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. Methods 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. Results 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. Conclusions 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.https://doi.org/10.1186/s12931-022-02151-1MR-proADMSARS-CoV-2MortalityHospital admissionEmergency department |
| spellingShingle | 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 MR-proADM SARS-CoV-2 Mortality Hospital admission Emergency department |
| title | Identification of COVID-19 patients at risk of hospital admission and mortality: a European multicentre retrospective analysis of mid-regional pro-adrenomedullin |
| title_full | Identification of COVID-19 patients at risk of hospital admission and mortality: a European multicentre retrospective analysis of mid-regional pro-adrenomedullin |
| title_fullStr | Identification of COVID-19 patients at risk of hospital admission and mortality: a European multicentre retrospective analysis of mid-regional pro-adrenomedullin |
| title_full_unstemmed | Identification of COVID-19 patients at risk of hospital admission and mortality: a European multicentre retrospective analysis of mid-regional pro-adrenomedullin |
| title_short | Identification of COVID-19 patients at risk of hospital admission and mortality: a European multicentre retrospective analysis of mid-regional pro-adrenomedullin |
| title_sort | identification of covid 19 patients at risk of hospital admission and mortality a european multicentre retrospective analysis of mid regional pro adrenomedullin |
| topic | MR-proADM SARS-CoV-2 Mortality Hospital admission Emergency department |
| url | https://doi.org/10.1186/s12931-022-02151-1 |
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