OBJECTIVE
To determine the predictive value of mid-regional proadrenomedullin (MR-proADM) in comparison with routine clinical and laboratory data in patients with the new coronavirus infection.
MATERIAL AND METHODS
A prospective single-center study included 97 adults aged 63 years (range 26.2—93.9) with COVID-19 infection and community-acquired pneumonia. In all patients, serum MR-proADM was analyzed upon admission in addition to routine clinical and laboratory analysis. KRYPTOR compact PLUS analyzer and appropriate kits of reagents (BRAHMS GmbH, Germany) were applied. We used News scale (National Early Warning Score) for primary assessment of patient condition. All patients were divided into 2 groups depending on the outcome of disease. Group 1 comprised of 83 (85.6%) patients who were discharged with recovery or improvement, group 2 — those who died in the hospital (n=14, 14.4%). Data are presented as absolute values, percentage, median and interquartile range (25—75th percentile). Mann—Whitney U-test was used to compare the variables. Differences were significant at p-value <0.05. ROC-analysis included the parameters with significant between-group differences.
RESULTS
Comorbidities, duration of COVID-19 infection, body mass index, severity of lung lesion (CT grade), body temperature, leukocyte and lymphocyte count, levels of C-reactive protein, lactate dehydrogenase, aminotransferases, fibrinogen and D-dimers were similar in both groups. Dead patients were significantly older (69.7 (60.9—82.1) vs. 62.5 (50.9—70.6) years, p=0.04), had less saturation (SpO2) (91 (87—93) vs. 92 (92—93)%, p=0.03), higher NEWS score (7 (6—8) vs. 6 (5—7) points, p=0.03), procalcitonin (0.16 (0.11—0.28) vs. 0.1 (0.07—0.17) ng/ml, p=0.03) and MR-proADM (1.215 (0.874—1.683) vs. 0.766 (0.631—0.948) nmol/L, p=0.002). MR-proADM (cut-off 0.895 nmol/L, AUC ROC 0.75 (0.59—0.91), sensitivity 71%, specificity 70%, OR 5.8, 95% CI 1.7—20.3) was the most significant predictor of mortality. PCT (cut-off 0.15 ng/ml, AUC ROC 0.68 (0.54—0.82), sensitivity 64%, specificity 70%, OR 3.9, 95% CI 1.2—13.2), SpO2 (cut-off 92%, AUC ROC 0.68 (0.51—0.85), sensitivity 78%, specificity 50%, OR 9.75 95% CI 2.25—42.3) and NEWS score (cut-off 6 points, AUC ROC 0.67 (0.52—0.82), sensitivity 64%, specificity 61%, OR 3, 95% CI 1.1—9.7) were less significant predictors.
CONCLUSION
Mid-regional proadrenomedullin is the most significant predictor of mortality in patients with the new coronavirus infection and pneumonia compared to procalcitonin, saturation and NEWS score.
