Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Eur J Clin Invest. 2022 May;52(5):e13753. doi: 10.1111/eci.13753. Epub 2022 Feb 7.
Biomarkers are used for diagnosis, risk stratification and medical decisions. Copeptin and mid-regional proadrenomedullin (MR-proADM) are markers of stress and endothelial function, respectively, which have been studied in pneumonia, sepsis and septic shock. This study aimed to assess whether copeptin and MR-proADM could predict coronavirus disease 2019 (COVID-19) in-hospital outcomes, that is multi-system complications, length of stay and mortality.
Copeptin and MR-proADM were assessed at admission in 116 patients hospitalized with COVID-19. Data were retrospectively extracted from an online database. The primary endpoint was in-hospital mortality. The secondary endpoints were in-hospital complications, the composite outcome 'death, or admission to intensive care unit, or in-hospital complications', and length of stay. The predictive power was expressed as area under the receiver operator characteristic curve (AUROC).
Copeptin was increased in non-survivors (median 29.7 [interquartile range 13.0-106.2] pmol/L) compared to survivors (10.9 [5.9-25.3] pmol/L, p < 0.01). The AUROC for mortality was 0.71, with a hazard ratio of 3.67 (p < 0.01) for copeptin values > 25.3 pmol/L. MR-proADM differentiated survivors (0.8 [0.6-1.1] nmol/L) from non-survivors (1.5 [1.1-2.8] nmol/L, p < 0.001) and yielded a AUROC of 0.79 and a hazard ratio of 7.02 (p < 0.001) for MR-proADM values > 1.0 nmol/L. Copeptin and MR-proADM predicted sepsis (AUROC 0.95 and 0.96 respectively), acute kidney injury (0.87 and 0.90), the composite outcome (0.69 and 0.75) and length of stay (r = 0.42, p < 0.001, and r = 0.46, p < 0.001).
Admission MR-proADM and copeptin may be implemented for early risk stratification in COVID-19-hospitalized patients to help identify those eligible for closer monitoring and care intensification.
生物标志物用于诊断、风险分层和医疗决策。 copeptin 和中区域 proadrenomedullin（MR-proADM）分别是应激和内皮功能的标志物，已在肺炎、脓毒症和感染性休克中进行了研究。本研究旨在评估 copeptin 和 MR-proADM 是否可以预测 2019 年冠状病毒病（COVID-19）住院患者的结局，即多系统并发症、住院时间和死亡率。
在 116 例因 COVID-19 住院的患者入院时评估了 copeptin 和 MR-proADM。数据从在线数据库中回顾性提取。主要终点为住院死亡率。次要终点为住院并发症、“死亡、入住重症监护病房或住院并发症”的复合结局以及住院时间。预测能力表示为接收器操作特征曲线（AUROC）下的面积。
与幸存者（10.9 [5.9-25.3] pmol/L，p<0.01）相比，非幸存者的 copeptin 升高（中位数 29.7 [13.0-106.2] pmol/L）。死亡率的 AUROC 为 0.71，copeptin 值>25.3 pmol/L 的危险比为 3.67（p<0.01）。MR-proADM 将幸存者（0.8 [0.6-1.1] nmol/L）与非幸存者（1.5 [1.1-2.8] nmol/L，p<0.001）区分开来，AUROC 为 0.79，MR-proADM 值>1.0 nmol/L 的危险比为 7.02（p<0.001）。copeptin 和 MR-proADM 预测败血症（AUROC 分别为 0.95 和 0.96）、急性肾损伤（0.87 和 0.90）、复合结局（0.69 和 0.75）和住院时间（r=0.42，p<0.001，和 r=0.46，p<0.001）。
入院时的 MR-proADM 和 copeptin 可用于对 COVID-19 住院患者进行早期风险分层，以帮助确定那些有资格接受更密切监测和强化护理的患者。
