{"title":"2019年冠状病毒病危重症和非危重症患者：哪个是疾病严重程度和结局最具预测性的生物标志物？一项多中心前瞻性队列研究，比较中部地区肾上腺髓质素、炎症和免疫模式。","authors":"Giorgia Montrucchio, Eleonora Balzani, Gabriele Sales, Cesare Bolla, Cristina Sarda, Andrea Della Selva, Massimo Perotto, Fulvio Pomero, Enrico Ravera, Francesca Rumbolo, Tiziana Callegari, Vito Fanelli, Giulio Mengozzi, Luca Brazzi","doi":"10.1097/EA9.0000000000000039","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Severe acute respiratory syndrome-coronavirus-2 in coronavirus disease 2019 (COVID-19) patients leads to a wide range of clinical manifestations. The evaluation of mid-regional pro-adrenomedullin (MR-proADM) as a prognostic biomarker in noncritical wards (NON-ICU) and intensive care units (ICU), may have a potential in predicting disease severity and outcomes.</p><p><strong>Objective: </strong>To assess the difference in the prognostic power of MR-proADM in NON-ICU wards and in ICUs in a prospective multicentre cohort study.</p><p><strong>Design: </strong>From January to July 2021, all adult COVID-19 patients requiring admission for more than 48 h.</p><p><strong>Setting: </strong>One primary centre and two secondary centre hospitals.</p><p><strong>Patients: </strong>One hundred and twenty-three ICU and 77 NON-ICU patients.</p><p><strong>Intervention: </strong>MR-proADM, lymphocyte subpopulations and immunoglobulins were measured within 48 h and on days 3 and 7. A Log-rank test was used to compare survival curves, using a MR-proADM cut-off value of 1.5 nmol l<sup>-1</sup>. The predictive ability for mortality was compared using the area under the curve and 95% confidence interval (CI) of different receiver-operating characteristic curves.</p><p><strong>Main outcome measures: </strong>The first 48 h MR-proADM values were significantly higher in the ICU group (median value 1.10 [IQR, 0.80 to 1.73] pg ml<sup>-1</sup> vs. 0.90 [0.70 to 1.20] pg ml<sup>-1</sup>, <i>P</i> = 0.020), and statistically significant changes were observed over time for MR-proADM, CD3+, CD4+ and CD56+. In univariate analysis, MR-proADM was the only biomarker that significantly predicted mortality (<i>P</i> = 0.006). The logistic regression model showed an odds ratio for mortality equal to 1.83 (95% CI, 1.08 to 3.37) <i>P</i> = 0.035 for MR-proADM, 1.37 (1.15 to 1.68) <i>P</i> = 0.001 for MuLBSTA and 1.11 (1.05 to 1.18) <i>P</i> less than 0.001 for SAPS II.</p><p><strong>Conclusion: </strong>MR-proADM admission values and trends over time appear to be a suitable marker of illness severity and a patient's risk of mortality in both ICU and NON-ICU settings. Lymphocyte subpopulation dysfunction seems to play a role in defining the severity of COVID-19 but is limited to ICU setting.</p><p><strong>Trial registration: </strong>on clinicaltrials.gov, NCT04873388 registered on March 2020.</p>","PeriodicalId":520410,"journal":{"name":"European journal of anaesthesiology and intensive care","volume":"2 6","pages":"e0039"},"PeriodicalIF":0.0000,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798374/pdf/","citationCount":"0","resultStr":"{\"title\":\"Critical and non-critical coronavirus disease 2019 patients: which is the most predictive biomarker for disease severity and outcome?: A multicentre prospective cohort study comparing mid-regional pro-adrenomedullin, inflammatory and immunological patterns.\",\"authors\":\"Giorgia Montrucchio, Eleonora Balzani, Gabriele Sales, Cesare Bolla, Cristina Sarda, Andrea Della Selva, Massimo Perotto, Fulvio Pomero, Enrico Ravera, Francesca Rumbolo, Tiziana Callegari, Vito Fanelli, Giulio Mengozzi, Luca Brazzi\",\"doi\":\"10.1097/EA9.0000000000000039\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Severe acute respiratory syndrome-coronavirus-2 in coronavirus disease 2019 (COVID-19) patients leads to a wide range of clinical manifestations. The evaluation of mid-regional pro-adrenomedullin (MR-proADM) as a prognostic biomarker in noncritical wards (NON-ICU) and intensive care units (ICU), may have a potential in predicting disease severity and outcomes.</p><p><strong>Objective: </strong>To assess the difference in the prognostic power of MR-proADM in NON-ICU wards and in ICUs in a prospective multicentre cohort study.</p><p><strong>Design: </strong>From January to July 2021, all adult COVID-19 patients requiring admission for more than 48 h.</p><p><strong>Setting: </strong>One primary centre and two secondary centre hospitals.</p><p><strong>Patients: </strong>One hundred and twenty-three ICU and 77 NON-ICU patients.</p><p><strong>Intervention: </strong>MR-proADM, lymphocyte subpopulations and immunoglobulins were measured within 48 h and on days 3 and 7. A Log-rank test was used to compare survival curves, using a MR-proADM cut-off value of 1.5 nmol l<sup>-1</sup>. The predictive ability for mortality was compared using the area under the curve and 95% confidence interval (CI) of different receiver-operating characteristic curves.</p><p><strong>Main outcome measures: </strong>The first 48 h MR-proADM values were significantly higher in the ICU group (median value 1.10 [IQR, 0.80 to 1.73] pg ml<sup>-1</sup> vs. 0.90 [0.70 to 1.20] pg ml<sup>-1</sup>, <i>P</i> = 0.020), and statistically significant changes were observed over time for MR-proADM, CD3+, CD4+ and CD56+. In univariate analysis, MR-proADM was the only biomarker that significantly predicted mortality (<i>P</i> = 0.006). The logistic regression model showed an odds ratio for mortality equal to 1.83 (95% CI, 1.08 to 3.37) <i>P</i> = 0.035 for MR-proADM, 1.37 (1.15 to 1.68) <i>P</i> = 0.001 for MuLBSTA and 1.11 (1.05 to 1.18) <i>P</i> less than 0.001 for SAPS II.</p><p><strong>Conclusion: </strong>MR-proADM admission values and trends over time appear to be a suitable marker of illness severity and a patient's risk of mortality in both ICU and NON-ICU settings. Lymphocyte subpopulation dysfunction seems to play a role in defining the severity of COVID-19 but is limited to ICU setting.</p><p><strong>Trial registration: </strong>on clinicaltrials.gov, NCT04873388 registered on March 2020.</p>\",\"PeriodicalId\":520410,\"journal\":{\"name\":\"European journal of anaesthesiology and intensive care\",\"volume\":\"2 6\",\"pages\":\"e0039\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-11-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11798374/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European journal of anaesthesiology and intensive care\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1097/EA9.0000000000000039\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/12/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European journal of anaesthesiology and intensive care","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/EA9.0000000000000039","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/12/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
Critical and non-critical coronavirus disease 2019 patients: which is the most predictive biomarker for disease severity and outcome?: A multicentre prospective cohort study comparing mid-regional pro-adrenomedullin, inflammatory and immunological patterns.
Background: Severe acute respiratory syndrome-coronavirus-2 in coronavirus disease 2019 (COVID-19) patients leads to a wide range of clinical manifestations. The evaluation of mid-regional pro-adrenomedullin (MR-proADM) as a prognostic biomarker in noncritical wards (NON-ICU) and intensive care units (ICU), may have a potential in predicting disease severity and outcomes.
Objective: To assess the difference in the prognostic power of MR-proADM in NON-ICU wards and in ICUs in a prospective multicentre cohort study.
Design: From January to July 2021, all adult COVID-19 patients requiring admission for more than 48 h.
Setting: One primary centre and two secondary centre hospitals.
Patients: One hundred and twenty-three ICU and 77 NON-ICU patients.
Intervention: MR-proADM, lymphocyte subpopulations and immunoglobulins were measured within 48 h and on days 3 and 7. A Log-rank test was used to compare survival curves, using a MR-proADM cut-off value of 1.5 nmol l-1. The predictive ability for mortality was compared using the area under the curve and 95% confidence interval (CI) of different receiver-operating characteristic curves.
Main outcome measures: The first 48 h MR-proADM values were significantly higher in the ICU group (median value 1.10 [IQR, 0.80 to 1.73] pg ml-1 vs. 0.90 [0.70 to 1.20] pg ml-1, P = 0.020), and statistically significant changes were observed over time for MR-proADM, CD3+, CD4+ and CD56+. In univariate analysis, MR-proADM was the only biomarker that significantly predicted mortality (P = 0.006). The logistic regression model showed an odds ratio for mortality equal to 1.83 (95% CI, 1.08 to 3.37) P = 0.035 for MR-proADM, 1.37 (1.15 to 1.68) P = 0.001 for MuLBSTA and 1.11 (1.05 to 1.18) P less than 0.001 for SAPS II.
Conclusion: MR-proADM admission values and trends over time appear to be a suitable marker of illness severity and a patient's risk of mortality in both ICU and NON-ICU settings. Lymphocyte subpopulation dysfunction seems to play a role in defining the severity of COVID-19 but is limited to ICU setting.
Trial registration: on clinicaltrials.gov, NCT04873388 registered on March 2020.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
