Predictive Value of MR-proADM in the Risk Stratification and in the Adequate Care Setting of COVID-19 Patients Assessed at the Triage of the Emergency Department

Abstract

In the past two pandemic years, Emergency Departments (ED) have been overrun with COVID-19-suspicious patients. Some data on the role played by laboratory biomarkers in the early risk stratification of COVID-19 patients have been recently published. The aim of this study is to assess the potential role of the new biomarker mid-regional proadrenomedullin (MR-proADM) in stratifying the in-hospital mortality risk of COVID-19 patients at the triage. A further goal of the present study is to evaluate whether MR-proADM together with other biochemical markers could play a key role in assessing the correct care level of these patients. Data from 321 consecutive patients admitted to the triage of the ED with a COVID-19 infection were analyzed. Epidemiological; demographic; clinical; laboratory; and outcome data were assessed. All the biomarkers analyzed showed an important role in predicting mortality. In particular, an increase of MR-proADM level at ED admission was independently associated with a threefold higher risk of IMV. MR-proADM showed greater ROC curves and AUC when compared to other laboratory biomarkers for the primary endpoint such as in-hospital mortality, except for CRP. This study shows that MR-proADM seems to be particularly effective for early predicting mortality and the need of ventilation in COVID-19 patients admitted to the ED.

Keywords: COVID-19 biomarkers; emergency department; mid-regional proadrenomedullin; triage.

Figure 1

Association of candidate biomarkers with mortality and mechanical ventilation. AUROC, Area Under the Receiver Operating Characteristic curve. MR-proADM, mid-regional prodrenomedullin; CRP, C-reactive protein; PCT, procalcitonin; LDH, lactate dehydrogenase; IMV, Invasive Mechanical Ventilation; NIMV, Non-Invasive Mechanical Ventilation.

Figure 2

Kaplan–Meier survival curves. Stratification of patients with mid-regional proadrenomedullin (MR-proADM) levels greater or less than 1.105 nmol/L and C-reactive protein (CRP) levels greater or less than 95.5 mg/L at admission in the Emergency Department. IMV, Invasive Mechanical Ventilation; NIMV, Non-Invasive Mechanical Ventilation.

Figure 3

Kaplan–Meier survival curves. Risk stratification of patients with procalcitonin (PCT) levels greater or less than 0.095 ng/mL, D-dimer levels greater or less than 985.5 ng/mL and lactate dehydrogenase (LDH) greater or less than 439.5 U/L at admission in the Emergency Department. IMV, invasive mechanical ventilation; NIMV, non-invasive mechanical ventilation.