MR-pro 肾上腺髓质素作为 COVID-19 危重症患者队列中肾脏替代治疗的预测指标。

MR-proAdrenomedullin as a predictor of renal replacement therapy in a cohort of critically ill patients with COVID-19.

机构信息

Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Institute of Clinical Chemistry and Laboratory Medicine, University Medical Centre Eppendorf, Hamburg, Germany.

出版信息

Biomarkers. 2021 Jul;26(5):417-424. doi: 10.1080/1354750X.2021.1905067. Epub 2021 Apr 5.

DOI:10.1080/1354750X.2021.1905067

PMID:33754916

Abstract

BACKGROUND

About 20% of ICU patients with COVID-19 require renal replacement therapy (RRT). Mid-regional pro-adrenomedullin (MR-proADM) might be used for risk assessment. This study investigates MR-proADM for RRT prediction in ICU patients with COVID-19.

METHODS

We analysed data of consecutive patients with COVID-19, requiring ICU admission at a university hospital in Germany between March and September 2020. Clinical characteristics, details on AKI, and RRT were assessed. MR-proADM was measured on admission.

RESULTS

64 patients were included (49 (77%) males). Median age was 62.5y (54-73). 47 (73%) patients were ventilated and 50 (78%) needed vasopressors. 25 (39%) patients had severe ARDS, and 10 patients needed veno-venous extracorporeal membrane oxygenation. 29 (45%) patients required RRT; median time from admission to RRT start was 2 (1-9) days. MR-proADM on admission was higher in the RRT group (2.491 vs. 1.23 nmol/l; = 0.002) and showed the highest correlation with renalSOFA. ROC curve analysis showed that MR-proADM predicts RRT with an AUC of 0.69 (95% CI: 0.543-0.828; = 0.019). In multivariable logistic regression MR-proADM was an independent predictor (OR: 3.813, 95% CI 1.110-13.102, <0.05) for RRT requirement.

CONCLUSION

AKI requiring RRT is frequent in ICU patients with COVID-19. MR-proADM on admission was able to predict RRT requirement, which may be of interest for risk stratification and management.

摘要

背景

约 20%的 COVID-19 重症监护病房（ICU）患者需要肾脏替代治疗（RRT）。中区域原促肾上腺皮质素（MR-proADM）可用于风险评估。本研究旨在探讨 ICU 中 COVID-19 患者中 RRT 的 MR-proADM 预测。

方法

我们分析了 2020 年 3 月至 9 月期间在德国一家大学医院入住 ICU 的连续 COVID-19 患者的数据。评估了临床特征、急性肾损伤（AKI）的详细情况和 RRT。入院时测量了 MR-proADM。

结果

共纳入 64 例患者（49 例[77%]男性）。中位年龄为 62.5 岁（54-73 岁）。47 例（73%）患者需要机械通气，50 例（78%）需要升压药物。25 例（39%）患者患有严重急性呼吸窘迫综合征（ARDS），10 例患者需要静脉-静脉体外膜肺氧合（ECMO）。29 例（45%）患者需要 RRT；从入院到开始 RRT 的中位时间为 2（1-9）天。RRT 组入院时的 MR-proADM 更高（2.491 比 1.23 nmol/L； = 0.002），与肾脏 SOFA 的相关性最高。ROC 曲线分析表明，MR-proADM 预测 RRT 的 AUC 为 0.69（95%CI：0.543-0.828； = 0.019）。多变量逻辑回归分析显示，MR-proADM 是 RRT 需求的独立预测因子（OR：3.813，95%CI 1.110-13.102，<0.05）。