前肾上腺髓质素在新型冠状病毒肺炎患者中的预后价值

Prognostic value of proadrenomedullin in patients with COVID-19 pneumonia.

作者信息

Astapovskii Aleksandr A, Drozdov Vladimir N, Shikh Evgenia V, Melkonyan George G, Sizova Zhanna M, Zakharova Valeria L, Shindryaeva Natalia N, Lapidus Natalia I

机构信息

Department of Clinical Pharmacology and Propedeutics of Internal Diseases, First Moscow State Medical University Named After I.M. Sechenov, Moscow, Russia.

Department of Health, Moscow Veterans Hospital No3, Moscow, Russia.

出版信息

Front Med (Lausanne). 2022 Aug 22;9:961071. doi: 10.3389/fmed.2022.961071. eCollection 2022.

DOI:10.3389/fmed.2022.961071

PMID:36072940

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9441885/

Abstract

OBJECTIVE

The aim of the study was to assess the role of mid-regional proadrenomedullin (MR-proADM) in comparison with routine laboratory tests in patients with COVID-19.

MATERIALS AND METHODS

140 hospitalized patients aged 18 and older with COVID-19 pneumonia were included in prospective single-center study. Routine analyses were performed, and MR-proADM level was measured within the first and the third hospital days using Human MR pro-ADM (Mid-regional pro-adrenomedullin) ELISA Kit with a sensitivity of 0.469 pmol/L (immunofluorescence assay). National Early Warning Score (NEWS) was used for primary assessment of the disease severity. According to disease outcome the patients were divided into two groups: discharged patients ( = 110, 78.6%) and deceased patients ( = 30, 21.4%). Results: The groups had no statistically significant difference in sex, comorbidity, body temperature, oxygen saturation level, heart rate, respiratory rate, and C-reactive protein (CRP) level and procalcitonin (PCT). The deceased patients had statistically significant difference in age (median, 76 years; interquartile range, 73.2-78.2 vs. median, 66 years; interquartile range, 62-67; < 0.0001), NEWS value (median, 5; interquartile range, 3-8 vs. median, 2; interquartile range, 0-6; <0.05), hospitalization period (median, 17; interquartile range, 7-35 vs. median, 6; interquartile range, 3-14), quantitative CT extent of lung damage > 50% [ = 26 (86.7%) vs. = 9 (8.2%) < 0.0001], level of leukocytes (median, 11.4 ×109/L; interquartile range, 6.2-15.5 vs. median, 5.3 ×109/L; interquartile range, 4.7-6.4; = 0.003), level of neutrophils (median, 80.9%; interquartile range, 73.6-88.6 vs. median, 72.6%; interquartile range, 68.7-76.9; = 0.027), level of MR-proADM at the first hospital day (median, 828.6 pmol/L; interquartile range, 586.4-1,184.6 vs. median, 492.6 pmol/L; interquartile range, 352.9-712.2; = 0.02), and level of MR-proADM at the third hospital day (median, 1,855.2 pmol/L; interquartile range, 1,078.4-2,596.5 vs. median, 270.7 pmol/L; interquartile range, 155.06-427.1).

CONCLUSION

Mid-regional proadrenomedullin has a higher prognostic value in patients with COVID-19 in comparison with routine inflammatory markers (leukocyte and neutrophils levels, CRP, and PCT) and NEWS.

摘要

目的

本研究旨在评估中段肾上腺髓质素原（MR-proADM）在新型冠状病毒肺炎（COVID-19）患者中相对于常规实验室检查的作用。

材料与方法

140例年龄18岁及以上的COVID-19肺炎住院患者纳入前瞻性单中心研究。进行常规分析，并在入院第1天和第3天使用灵敏度为0.469 pmol/L的人MR-proADM（中段肾上腺髓质素原）酶联免疫吸附测定试剂盒（免疫荧光法）测量MR-proADM水平。采用国家早期预警评分（NEWS）对疾病严重程度进行初步评估。根据疾病转归将患者分为两组：出院患者（n = 110，78.6%）和死亡患者（n = 30，21.4%）。结果：两组在性别、合并症、体温、血氧饱和度水平、心率、呼吸频率、C反应蛋白（CRP）水平和降钙素原（PCT）方面无统计学显著差异。死亡患者在年龄（中位数76岁；四分位间距73.2 - 78.2岁 vs. 中位数66岁；四分位间距62 - 67岁；P < 0.0001）、NEWS值（中位数5；四分位间距3 - 8 vs. 中位数2；四分位间距0 - 6；P < 0.05）、住院时间（中位数17天；四分位间距7 - 35天 vs. 中位数6天；四分位间距3 - 14天）、肺部损伤定量CT范围> 50%[n = 26（86.7%） vs. n = 9（8.2%）；P < 0.0001]、白细胞水平（中位数11.4×10⁹/L；四分位间距6.2 - 15.5 vs. 中位数5.3×10⁹/L；四分位间距4.7 - 6.4；P = 0.003）、中性粒细胞水平（中位数80.9%；四分位间距73.6 - 88.6% vs. 中位数72.6%；四分位间距68.7 - 76.9%；P = 0.027）、入院第1天的MR-proADM水平（中位数828.6 pmol/L；四分位间距586.4 - 1184.6 pmol/L vs. 中位数492.6 pmol/L；四分位间距352.9 - 712.2 pmol/L；P = 0.02）以及入院第3天的MR-proADM水平（中位数1855.2 pmol/L；四分位间距1078.4 - 2596.5 pmol/L vs. 中位数270.7 pmol/L；四分位间距155.06 - 427.1 pmol/L）方面存在统计学显著差异。