Identification of COVID-19 patients at risk of hospital admission and mortality: a European multicentre retrospective analysis of mid-regional pro-adrenomedullin.
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Sozio Emanuela, Moore Nathan A, Fabris Martina, Ripoli Andrea, Rumbolo Francesca, Minieri Marilena, Boverio Riccardo, Rodríguez Mulero María Dolores, Lainez-Martinez Sara, Martínez Martínez Mónica, Calvo Dolores, Gregoriano Claudia, Williams Rebecca, Brazzi Luca, Terrinoni Alessandro, Callegari Tiziana, Hernández Olivo Marta, Esteban-Torrella Patricia, Calcerrada Ismael, Bernasconi Luca, Kidd Stephen P, Sbrana Francesco, Miguens Iria, Gordon Kirsty, Visentini Daniela, Legramante Jacopo M, Bassi Flavio, Cortes Nicholas, Montrucchio Giorgia, Di Lecce Vito N, Lauritano Ernesto C, García de Guadiana-Romualdo Luis, González Del Castillo Juan, Bernal-Morell Enrique, Andaluz-Ojeda David, Schuetz Philipp, Curcio Francesco, Tascini Carlo, Saeed Kordo
Аннотация
METHODS: An observational retrospective analysis of 1861 patients, with SARS-CoV-2 confirmed by RT-qPCR, from 10 hospitals across Europe was performed. Biomarkers, taken upon presentation to Emergency Departments (ED), clinical scores, patient demographics and outcomes were collected. Multiclass random forest classifier models were generated as well as calculation of area under the curve analysis. The primary endpoint was hospital admission with and without death.
RESULTS: Patients suitable for safe discharge from Emergency Departments could be identified through an MR-proADM value of ≤ 1.02 nmol/L in combination with a CRP (C-Reactive Protein) of ≤ 20.2 mg/L and age ≤ 64, or in combination with a SOFA (Sequential Organ Failure Assessment) score < 2 if MR-proADM was ≤ 0.83 nmol/L regardless of age. Those at an increased risk of mortality could be identified upon presentation to secondary care with an MR-proADM value of > 0.85 nmol/L, in combination with a SOFA score ≥ 2 and LDH > 720 U/L, or in combination with a CRP > 29.26 mg/L and age ≤ 64, when MR-proADM was > 1.02 nmol/L.
CONCLUSIONS: This international study suggests that for patients presenting to the ED with confirmed SARS-CoV-2 infection, MR-proADM in combination with age and CRP or with the patient's SOFA score could identify patients at low risk where outpatient treatment may be safe.