Abstract
ObjectivesThromboinflammation, 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.MethodsA 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.ResultsA 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])ConclusionsOur data confirm that MR-proADM has a role in the mid-term prognosis of COVID-19 patients and might assist physicians with risk stratification.
Highlights
Because the vascular endothelium constitutes a cellular barrier playing a crucial role in the maintenance of vessel integrity, endothelial damage and dysfunction may be prominent features of COVID19 induced severe illness (Stein and Young, 2021; Wilson et al, 2020) endothelial biomarkers should be evaluated for their value in the risk stratification of COVID-19 patients (Evans et al, 2020)
We aimed to evaluate the role of MRproADM with regards to the prediction of severity in hospitalized patients by SARS-CoV-2 infection, focusing on a longer period after the index event (90 days), in a large cohort including patients in the second wave
We developed a full non-parsimonious logistic regression model to derive a propensity-score for the prediction of high circulating MR-proADM levels with eleven independent variables
Summary
Because the vascular endothelium constitutes a cellular barrier playing a crucial role in the maintenance of vessel integrity, endothelial damage and dysfunction may be prominent features of COVID19 induced severe illness (Stein and Young, 2021; Wilson et al, 2020) endothelial biomarkers should be evaluated for their value in the risk stratification of COVID-19 patients (Evans et al, 2020). In this sense, adrenomedullin (ADM) is a key hormone secreted by endothelial and vascular smooth muscle cells, playing a role as an endothelial barrier function-stabilizing agent (Tay et al, 2020; van Lier et al, 2020) (Figure 1).
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