Critical and non-critical coronavirus disease 2019 patients: which is the most predictive biomarker for disease severity and outcome??: A multicentre prospective cohort study comparing mid-regional pro-adrenomedullin, inflammatory and immunological patterns

Montrucchio, G; Balzani, E; Sales, G; Bolla, C; Sarda, C; Della Selva, A; Perotto, M; Pomero, F; Ravera, E; Rumbolo, F; Callegari, T; Fanelli, V; Mengozzi, G; Brazzi, L

doi:10.1097/ea9.0000000000000039

Sepsis & infection

Critical and non-critical coronavirus disease 2019 patients: which is the most predictive biomarker for disease severity and outcome??: A multicentre prospective cohort study comparing mid-regional pro-adrenomedullin, inflammatory and immunological patterns

Eur J Anaesthesiol Intensive CarePublished 21 Nov 2023Prospective cohort study

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Authors' conclusion

MR-proADM admission values and trends over time appear to be a suitable marker of illness severity and a patient's risk of mortality in both ICU and NON-ICU settings. Lymphocyte subpopulation dysfunction seems to play a role in defining the severity of COVID-19 but is limited to ICU setting.

Study context

Population: Adult COVID-19 patients requiring admission for more than 48 h, January to July 2021, one primary and two secondary centre hospitals
Participants: 123 vs 77

Exposure: Intensive care units (ICU) vs NON-ICU COVID-19 patients
ICUn = 123
NON-ICUn = 77reference
Outcome: First 48 h MR-proADM values, ICU vs NON-ICU
Follow-up: First 48 h

Methodological detailsmulticentre

Multicentre

Main finding

As reported in the abstract

MR-proADM values

ICU1.10median · IQR 0.80–1.73 · pg ml-1

NON-ICU0.90median · IQR 0.70–1.20 · pg ml-1

P = 0.020

Observational data: associations, not effects.

Further findings

Mortality, logistic regression

	← Lower odds ←→ Higher odds →	OR (95% CI)	P value
MR-proADM	0.20.5125	1.83 (1.08–3.37)	P = 0.035
MuLBSTA	0.20.5125	1.37 (1.15–1.68)	P = 0.001
SAPS II	0.20.5125	1.11 (1.05–1.18)	P less than 0.001
	0.20.5125Odds ratio (log scale)

Change over time in mid-regional pro-adrenomedullin (MR-proADM), CD3+, CD4+ and CD56+ · within 48 h, days 3 and 7

Statistically significant changes over time

Prediction of mortality, univariate analysis

MR-proADM the only biomarker significantly predicting mortality: P = 0.006

Original publication

Critical and non-critical coronavirus disease 2019 patients: which is the most predictive biomarker for disease severity and outcome??: A multicentre prospective cohort study comparing mid-regional pro-adrenomedullin, inflammatory and immunological patterns. Eur J Anaesthesiol Intensive Care. Published 21 November 2023. doi:10.1097/ea9.0000000000000039

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