![]() Thus, ADM may also be of interest within COVID-19 induced endotheliitis. Adrenomedullin (ADM) is a potent vasodilatory peptide hormone produced by endothelial cells and plays a key role in reducing vascular permeability and promoting endothelial stability and integrity following severe infection. Recent studies, pre COVID-19, have shown mid-regional pro-adrenomedullin (MR-proADM) concentrations to be rapidly induced in the initial stages of sepsis development and progression towards sepsis-related multiple organ failure and can assist triaging in the emergency department and safely avoid admission. The progressive multi-organ failure associated with SARS-CoV-2 mortality is driven in part by significant inflammation and microvascular thrombosis. The presence of SARS-CoV-2 within the endothelium can lead to a secondary endotheliitis that promotes an impairment of vascular blood flow, a pro-thrombotic state and vascular leakage. The use of biomarkers which have a high sensitivity for assessing disease severity and significantly increased during the initial stages of the disease development may therefore facilitate improved triaging and earlier therapeutic decisions. The effect of this could be either unnecessary admission of patients with uncomplicated infections or inappropriate discharges. In these circumstances, trying to determine those in whom admission can be safely avoided, those who need admission and those who need admission to higher level care facilities could become even more of a challenge to already stretched emergency clinical staff. This large number of cases has resulted in substantial demand being placed upon healthcare systems and resulted in over 5.2 million deaths. Whilst most cases are asymptomatic or defined by mild symptoms, up to 15% of all cases develop severe pathology. There have now been over 265 million cases worldwide of SARS-CoV-2 infection since the end of 2019. An early diagnosis and assessment of infection severity is therefore crucial in order to initiate triaging and appropriate therapeutic strategies. ![]() Infections due to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) are not exempt from this. 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.Īll infections have the potential to manifest into life-threatening conditions. 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 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. The primary endpoint was hospital admission with and without death. Multiclass random forest classifier models were generated as well as calculation of area under the curve analysis. ![]() Biomarkers, taken upon presentation to Emergency Departments (ED), clinical scores, patient demographics and outcomes were collected. MethodsĪn observational retrospective analysis of 1861 patients, with SARS-CoV-2 confirmed by RT-qPCR, from 10 hospitals across Europe was performed. An evaluation of its utility in predicting need for hospitalisation in viral infections was also performed. A limited number of small and monocentric studies have examined MR-proADM as a prognostic factor in patients infected with SARS-CoV-2, however there is need for multicenter validation. Previous studies of MR-proADM have primarily focussed on bacterial infections. Mid-Regional pro-Adrenomedullin (MR-proADM) is an inflammatory biomarker that improves the prognostic assessment of patients with sepsis, septic shock and organ failure. Respiratory Research volume 23, Article number: 221 ( 2022) 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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