Varaldo Emanuele, Rumbolo Francesca, Prencipe Nunzia, Bioletto Fabio, Settanni Fabio, Mengozzi Giulio, Grottoli Silvia, Ghigo Ezio, Brazzi Luca, Montrucchio Giorgia, Berton Alessandro Maria
Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy.
Clinical Chemistry and Microbiology Laboratory, S. Croce and Carle Cuneo Hospital, 12100 Cuneo, Italy.
J Clin Med. 2024 Mar 30;13(7):2019. doi: 10.3390/jcm13072019.
To investigate whether copeptin, MR-proADM and MR-proANP, alone or integrated with the SOFA, MuLBSTA and SAPS II scores, are capable of early recognition of COVID-19 ICU patients at increased risk of adverse outcomes. For this predefined secondary analysis of a larger cohort previously described, all consecutive COVID-19 adult patients admitted between March and December 2020 to the ICU of a referral, university hospital in Northern Italy were screened, and clinical severity scores were calculated upon admission. A blood sample for copeptin, MR-proADM and MR-proANP was collected within 48 h (T1), on day 3 (T3) and 7 (T7). Outcomes considered were ICU and in-hospital mortality, bacterial superinfection, recourse to renal replacement therapy (RRT) or veno-venous extracorporeal membrane oxygenation, need for invasive mechanical ventilation (IMV) and pronation. Sixty-eight patients were enrolled, and in-hospital mortality was 69.1%. ICU mortality was predicted by MR-proANP measured at T1 (HR 1.005, 95% CI 1.001-1.010, = 0.049), although significance was lost if the analysis was adjusted for procalcitonin and steroid treatment ( = 0.056). Non-survivors showed higher MR-proADM levels than survivors at all time points, and an increase in the ratio between values at baseline and at T7 > 4.9% resulted in a more than four-fold greater risk of in-hospital mortality (HR 4.417, < 0.001). Finally, when considering patients with any reduction in glomerular filtration, an early copeptin level > 23.4 pmol/L correlated with a more than five-fold higher risk of requiring RRT during hospitalization (HR 5.305, = 0.044). Timely evaluation of MR-proADM, MR-proANP and copeptin, as well as changes in the former over time, might predict mortality and other adverse outcomes in ICU patients suffering from severe COVID-19.
为研究 copeptin、MR-proADM 和 MR-proANP 单独使用或与序贯器官衰竭评估（SOFA）、多因素改良早期预警评分（MuLBSTA）及简化急性生理学评分 II（SAPS II）相结合，是否能够早期识别出新型冠状病毒肺炎（COVID-19）重症监护病房（ICU）中不良结局风险增加的患者。在对先前描述的一个更大队列进行的这项预定义的二次分析中，对 2020 年 3 月至 12 月期间入住意大利北部一家转诊大学医院 ICU 的所有连续性 COVID-19 成年患者进行筛查，并在入院时计算临床严重程度评分。在 48 小时内（T1）、第 3 天（T3）和第 7 天（T7）采集用于检测 copeptin、MR-proADM 和 MR-proANP 的血样。所考虑的结局包括 ICU 死亡率和院内死亡率、细菌二重感染、是否需要肾脏替代治疗（RRT）或静脉 - 静脉体外膜肺氧合、是否需要有创机械通气（IMV）以及俯卧位通气。纳入 68 例患者，院内死亡率为 69.1%。T1 时检测的 MR-proANP 可预测 ICU 死亡率（风险比 1.005，95%置信区间 1.001 - 1.010，P = 0.049），不过如果分析针对降钙素原和类固醇治疗进行校正，该显著性消失（P = 0.056）。在所有时间点，非存活者的 MR-proADM 水平均高于存活者，且基线值与 T7 值之比增加>4.9%会使院内死亡风险增加四倍多（风险比 4.417，P<0.001）。最后，在考虑肾小球滤过率有任何降低的患者时，早期 copeptin 水平>23.4 pmol/L 与住院期间需要 RRT 的风险高出五倍多相关（风险比 5.305，P = 0.044）。及时评估 MR-proADM、MR-proANP 和 copeptin 以及前者随时间的变化，可能预测重症 COVID-19 的 ICU 患者的死亡率和其他不良结局。
