Рrognostic value of proadrenomedullin in patients with COVID-19

Abstract

Introduction. In the context of a pandemic, it is necessary to quickly and accurately stratify patients into groups based on  the severity of their condition and prognostic risk. For these purposes, some available biomarkers, such as proadrenomedullin, can be used. Objective. To determine the prognostic value of regional mean proadrenomedullin (pro-ADM) in comparison with routine clinical and laboratory parameters in patients with a new coronavirus infection COVID-19. Materials and methods. The study included 140 patients who were hospitalized with a diagnosis of community-acquired pneumonia on the background of COVID-19. The level of pro-ADM was determined on the first and third days of hospitalization by ELISA. In accordance with the outcome of the disease, patients were divided into two groups: those discharged with recovery or improvement (n = 110, 78, 6%) and those who died during their stay in the hospital (n = 30, 21, 4%). Results. Pro-ADM had the highest prognostic value as a predictor of adverse outcome on day 1 AUC ROC 0.72 95% CI (0.57–0.84) sensitivity 79.2%, specificity 62.9% and on day 3 AUC ROC 0.98 95% CI (0.86–1.0) sensitivity 100%, specificity 95.6%. ROC analysis results for C-reactive protein AUC ROC 0.55 95% CI (0.41–0.77), sensitivity 73.3%, specificity 45.6%; procalcitonin AUC ROC 0.62 95% CI (0.49–0.73), sensitivity 80%, specificity 48.2%. The relative risk of a poor outcome for a proADM level > 500 pmol/L is 2.3 95% CI (1.23–4.32), and for a proADM level > 700 it is 8.5 95% CI (4.83–14.94) p < 0.001. Conclusions. Compared to C-reactive protein and procalcitonin, regional mean proadrenomedullin has the highest predictive value as a predictor of death in patients with COVID-19.