Circulating MR-proADM levels, as an indicator of endothelial dysfunction, for early risk stratification of mid-term mortality in COVID-19 patients. (October 2021)

• Record Type: Journal Article
• Authors: García de Guadiana-Romualdo, Luis; Martínez Martínez, Mónica; Rodríguez Mulero, María Dolores; Esteban-Torrella, Patricia; Hernández Olivo, Marta; Alcaraz García, María José; Campos-Rodríguez, Valerio; Sancho-Rodríguez, Natalia; Galindo Martínez, María; Alcaraz, Antonia; Ros Braquehais, María Salomé; Báguena Perez-Crespo, Carlos; Ramos Arenas, Verónica; Tomás Jiménez, Cristina; Consuegra-Sánchez, Luciano; Conesa-Hernandez, Andrés; Piñera-Salmerón, Pascual; Bernal-Morell, Enrique
• Is Part Of: International journal of infectious diseases. Volume 111(2021)
• Page Start: 211
• Page End: 218
• Publication Date: 2021-10
• Subjects: Mid-regional proadrenomedullin -- SARS-CoV-2 -- COVID-19 -- endotheliopathy -- severity -- second wave; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2021.08.058
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Endotheliopathy is a pathological feature associated with thromboinflammation. Endothelial biomarkers may help the stratification of risk in COVID-19. Disruption of the adrenomedullin system contributes to endothelial dysfunction. MR-proADM might be useful for early risk stratification of COVID-19. 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.