Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Institute DECIPHER, German-Chilean Institute for Research on Pulmonary Hypoxia and Its Health Sequelae, Hamburg, Germany.
Sci Rep. 2021 May 10;11(1):9895. doi: 10.1038/s41598-021-89180-w.
COVID-19 is a disease with a variable clinical course ranging from mild symptoms to critical illness, organ failure, and death. Prospective biomarkers may help to predict the severity of an individual's clinical course and mortality risk. We analyzed asymmetric (ADMA) and symmetric dimethylarginine (SDMA) in blood samples from 31 patients hospitalized for COVID-19. We calculated associations of ADMA and SDMA with mortality and organ failure, and we developed a predictive algorithm based upon these biomarkers to predict mortality risk. Nine patients (29%) experienced in-hospital death. SDMA and ADMA serum concentrations were significantly higher at admission in COVID-19 patients who died than in survivors. Cut-offs of 0.90 µmol/L for SDMA (AUC, 0.904, p = 0.0005) and 0.66 µmol/L for ADMA (AUC, 0.874, p = 0.0013) were found in ROC analyses to best discriminate both subgroups of patients. Hazard ratio for in-hospital mortality was 12.2 (95% CI: 2.2-31.2) for SDMA and 6.3 (1.1-14.7) for ADMA above cut-off. Sequential analysis of both biomarkers allowed discriminating a high-risk group (87.5% mortality) from an intermediate-risk group (25% mortality) and a low-risk group (0% mortality). Elevated circulating concentrations of SDMA and ADMA may help to better identify COVID-19 patients with a high risk of in-hospital mortality.
COVID-19 是一种具有不同临床病程的疾病，从轻微症状到危重症、器官衰竭和死亡不等。前瞻性生物标志物可能有助于预测个体临床病程的严重程度和死亡风险。我们分析了 31 名因 COVID-19 住院的患者的血液样本中的不对称（ADMA）和对称二甲基精氨酸（SDMA）。我们计算了 ADMA 和 SDMA 与死亡率和器官衰竭的相关性，并基于这些生物标志物开发了一种预测算法，以预测死亡率风险。9 名患者（29%）在住院期间死亡。死亡的 COVID-19 患者入院时的 SDMA 和 ADMA 血清浓度明显高于幸存者。SDMA 的截断值为 0.90µmol/L（AUC，0.904，p=0.0005），ADMA 的截断值为 0.66µmol/L（AUC，0.874，p=0.0013），这两个截断值在 ROC 分析中可以最好地区分这两组患者。SDMA 的住院死亡率危险比为 12.2（95%CI：2.2-31.2），ADMA 的危险比为 6.3（1.1-14.7），超过了截断值。对这两种生物标志物的连续分析可以区分高风险组（87.5%的死亡率）、中风险组（25%的死亡率）和低风险组（0%的死亡率）。循环中 SDMA 和 ADMA 浓度的升高可能有助于更好地识别 COVID-19 患者的住院死亡率高风险。
