中段前心钠素原作为新冠病毒肺炎患者预后的预测因素

MR-proADM as Prognostic Factor of Outcome in COVID-19 Patients.

作者信息

Cameli Paolo, Pordon Elena, d'Alessandro Miriana, Marzi Maria Laura, Galasso Lucrezia, Biuzzi Cesare, Bergantini Laura, Bargagli Elena, Scolletta Sabino, Franchi Federico

机构信息

Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy.

Anesthesia and Intensive Care Unit, Department of Medicine, Surgery and Neurosciences, University Hospital of Siena, 53100 Siena, Italy.

出版信息

Biomedicines. 2023 Jun 9;11(6):1680. doi: 10.3390/biomedicines11061680.

DOI:10.3390/biomedicines11061680

PMID:37371775

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10296224/

Abstract

BACKGROUND

Serum mid-regional proadrenomedullin (MR-proADM) has emerged as a marker of organ failure (mainly lungs and kidneys) and poor prognosis in patients admitted to intensive care (IC); some reports also suggest it and other markers, such as Krebs von den Lungen-6 (KL-6) and interleukin-6 (IL-6), as a prognostic biomarker of COVID-19. The aim of the study was to evaluate the performance MR-proADM in hospitalized COVID-19 patients for predicting in-hospital mortality and need for non-invasive or invasive respiratory support.

METHODS

We enrolled 74 patients hospitalized in the COVID Unit of Siena Hospital from March to May 2020, for whom serum samples were available on admission for assay of MR-proADM, KL-6 and IL-6. Demographic data, comorbidities, medical history and clinical laboratory data on days 1-3 of admission and Simplified Acute Physiology Score and Simplified Organ Failure Assessment scores calculated at day 1 were collected retrospectively, as well as mortality and IC admission data.

RESULTS

12 patients died in hospital (16%) and 14 patients were admitted to IC (19%). Serum concentrations of MR-proADM on admission and on day 1 were higher among non-survivors than among survivors ( = 0.015 and = 0.045, respectively), while those on day 3 were not significantly different. Patients needing respiratory support had higher MR-proADM concentrations on admission than the others ( = 0.046), and those requiring invasive mechanical ventilation had higher MR-proADM on day 1 ( = 0.017). Serum concentrations of KL-6 and IL-6 were significantly higher in non-survivors ( = 0.03 and = 0.004, respectively). ROC curve analysis showed that serum MR-proADM on day 1 had the best accuracy in predicting death and/or IC admission (AUC = 0.9583, = 0.0006); the combination of all three biomarkers further improved the accuracy of prediction of death or IC admission (AUC = 0.9793; = 0.00004).

CONCLUSIONS

Our data sustain the potential of serum MR-proADM as a reliable prognostic biomarker of hospitalized COVID-19 patients and confirms the utility of the three markers in the management and risk stratification of hospitalized patients. The markers are collected mini-invasively and are quick to analyze and cost-effective.

摘要

背景

血清中段前肾上腺髓质素（MR-proADM）已成为器官功能衰竭（主要是肺和肾）的标志物，也是重症监护（IC）患者预后不良的指标；一些报告还表明，它与其他标志物，如克雷布斯肺表面活性蛋白-6（KL-6）和白细胞介素-6（IL-6），可作为COVID-19的预后生物标志物。本研究的目的是评估MR-proADM在COVID-19住院患者中预测院内死亡率及无创或有创呼吸支持需求的性能。

方法

我们纳入了2020年3月至5月在锡耶纳医院COVID病房住院的74例患者，这些患者入院时可获得血清样本，用于检测MR-proADM、KL-6和IL-6。回顾性收集患者的人口统计学数据、合并症、病史、入院第1至3天的临床实验室数据，以及第1天计算的简化急性生理学评分和简化器官功能衰竭评估评分，还有死亡率和入住重症监护病房的数据。

结果

12例患者在医院死亡（16%），14例患者入住重症监护病房（19%）。非幸存者入院时和第1天的MR-proADM血清浓度高于幸存者（分别为P = 0.015和P = 0.045），而第3天的浓度无显著差异。需要呼吸支持的患者入院时的MR-proADM浓度高于其他患者（P = 0.046），需要有创机械通气的患者第1天的MR-proADM浓度更高（P = 0.017）。非幸存者的KL-6和IL-6血清浓度显著更高（分别为P = 0.03和P = 0.004）。ROC曲线分析表明，第1天的血清MR-proADM在预测死亡和/或入住重症监护病房方面具有最佳准确性（AUC = 0.9583，P = 0.0006）；三种生物标志物的联合使用进一步提高了死亡或入住重症监护病房预测的准确性（AUC = 0.9793；P = 0.00004）。