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García de Guadiana-Romualdo L, Martínez Martínez M, Rodríguez Mulero MD, Esteban-Torrella P, Hernández Olivo M, Alcaraz García MJ, Campos-Rodríguez V, Sancho-Rodríguez N, Galindo Martínez M, Alcaraz A, Ros Braquehais MS, Báguena Perez-Crespo C, Ramos Arenas V, Tomás Jiménez C, Consuegra-Sánchez L, Conesa-Hernandez A, Piñera-Salmerón P, Bernal-Morell E. Circulating MR-proADM levels, as an indicator of endothelial dysfunction, for early risk stratification of mid-term mortality in COVID-19 patients. Int J Infect Dis 2021; 111:211-218. [PMID: 34461254 PMCID: PMC8400460 DOI: 10.1016/j.ijid.2021.08.058] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 12/23/2022] Open
Abstract
Objectives Thromboinflammation, resulting from a complex interaction between thrombocytopathy, coagulopathy, and endotheliopathy, contributes to increased mortality in COVID-19 patients. MR-proADM, as a surrogate of adrenomedullin system disruption, leading to endothelial damage, has been reported as a promising biomarker for short-term prognosis. We evaluated the role of MR-proADM in the mid-term mortality in COVID-19 patients. Methods A prospective, observational study enrolling COVID-19 patients from August to October 2020. A blood sample for laboratory test analysis was drawn on arrival in the emergency department. The primary endpoint was 90-day mortality. The area under the curve (AUC) and Cox regression analyses were used to assess discriminatory ability and association with the endpoint. Results A total of 359 patients were enrolled, and the 90-day mortality rate was 8.9%. ROC AUC for MR-proADM predicting 90-day mortality was 0.832. An optimal cutoff of 0.80 nmol/L showed a sensitivity of 96.9% and a specificity of 58.4%, with a negative predictive value of 99.5%. Circulating MR-proADM levels (inverse transformed), after adjusting by a propensity score including eleven potential confounders, were an independent predictor of 90-day mortality (HR: 0.162 [95% CI: 0.043-0.480]) Conclusions Our data confirm that MR-proADM has a role in the mid-term prognosis of COVID-19 patients and might assist physicians with risk stratification.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Antonia Alcaraz
- Infectious Disease Unit, Hospital General Universitario Reina Sofía, Murcia, Spain
| | | | | | - Verónica Ramos Arenas
- Laboratory Medicine Department, Hospital Universitario Santa Lucía, Cartagena, Spain
| | | | | | | | | | - Enrique Bernal-Morell
- Infectious Disease Unit, Hospital General Universitario Reina Sofía, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB).
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Kriechbaum SD, Scherwitz L, Wiedenroth CB, Rudolph F, Wolter JS, Haas M, Fischer-Rasokat U, Rolf A, Hamm CW, Mayer E, Guth S, Keller T, Konstantinides SV, Lankeit M, Liebetrau C. Mid-regional pro-atrial natriuretic peptide and copeptin as indicators of disease severity and therapy response in CTEPH. ERJ Open Res 2020; 6:00356-2020. [PMID: 33263045 PMCID: PMC7682678 DOI: 10.1183/23120541.00356-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/18/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Chronic thromboembolic pulmonary hypertension (CTEPH) leads to right heart failure. Pulmonary endarterectomy (PEA) or balloon pulmonary angioplasty (BPA) restore pulmonary haemodynamics and allow cardiac recovery. This study examined the relationship of copeptin and mid-regional pro-atrial natriuretic peptide (MR-proANP) levels to disease severity and therapy response. METHODS This observational cohort study included 125 patients (55 PEA/70 BPA) who underwent treatment and completed a 6-/12-month follow-up. Biomarkers, measured at baseline, prior to every BPA and at follow-up, were compared to 1) severe disease at baseline (right atrial pressure (RAP) ≥8 mmHg and cardiac index ≤2.4 L·min-1·m-2) and 2) optimal therapy response (no persistent pulmonary hypertension combined with a normalised RAP (mean PAP ≤25 mmHg, pulmonary vascular resistance (PVR) ≤3 WU and RAP ≤6 mmHg) or a reduction in mean PAP ≥25%, PVR ≥35% and RAP ≥25%). RESULTS Severely diseased patients had higher levels of MR-proANP (320 (246-527) pmol·L-1 versus 133 (82-215) pmol·L-1; p=0.001) and copeptin (12.7 (7.3-20.6) pmol·L-1 versus 6.8 (4.4-12.8) pmol·L-1; p=0.015) at baseline than the rest of the cohort. At baseline, MR-proANP (area under the curve (AUC) 0.91; cut-off value 227 pmol·L-1; OR 56, 95% CI 6.9-454.3) and copeptin (AUC 0.70; cut-off value 10.9 pmol·L-1; OR 1.5, 95% CI 1.2-1.9) identified severely diseased patients. After PEA/BPA, levels of MR-proANP (99 (58-145) pmol·L-1; p<0.001) and copeptin (6.3 (3.7-12.6) pmol·L-1; p=0.009) decreased and indicated optimal therapy response (MR-proANP <123 pmol·L-1 (AUC 0.70) and copeptin <10.1 pmol·L-1 (AUC 0.58)). CONCLUSION MR-proANP and copeptin levels are affected in CTEPH and decrease after therapy. MR-proANP identifies a severe disease status and optimal therapy response.
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Affiliation(s)
- Steffen D. Kriechbaum
- Kerckhoff Heart and Thorax Center, Dept of Cardiology, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
| | - Lillith Scherwitz
- Kerckhoff Heart and Thorax Center, Dept of Cardiology, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
| | | | - Felix Rudolph
- Kerckhoff Heart and Thorax Center, Dept of Cardiology, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
| | - Jan-Sebastian Wolter
- Kerckhoff Heart and Thorax Center, Dept of Cardiology, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
| | - Moritz Haas
- Kerckhoff Heart and Thorax Center, Dept of Cardiology, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
| | - Ulrich Fischer-Rasokat
- Kerckhoff Heart and Thorax Center, Dept of Cardiology, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
| | - Andreas Rolf
- Kerckhoff Heart and Thorax Center, Dept of Cardiology, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
- Justus Liebig University Giessen, Medical Clinic I, Division of Cardiology, Giessen, Germany
| | - Christian W. Hamm
- Kerckhoff Heart and Thorax Center, Dept of Cardiology, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
- Justus Liebig University Giessen, Medical Clinic I, Division of Cardiology, Giessen, Germany
| | - Eckhard Mayer
- Kerckhoff Heart and Thorax Center, Dept of Thoracic Surgery, Bad Nauheim, Germany
| | - Stefan Guth
- Kerckhoff Heart and Thorax Center, Dept of Thoracic Surgery, Bad Nauheim, Germany
| | - Till Keller
- Kerckhoff Heart and Thorax Center, Dept of Cardiology, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
- Justus Liebig University Giessen, Medical Clinic I, Division of Cardiology, Giessen, Germany
| | - Stavros V. Konstantinides
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Dept of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Mareike Lankeit
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Dept of Internal Medicine and Cardiology, Campus Virchow Klinikum (CVK), Charité - University Medicine Berlin, Berlin, Germany
- These authors contributed equally
| | - Christoph Liebetrau
- Kerckhoff Heart and Thorax Center, Dept of Cardiology, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Frankfurt am Main, Germany
- Justus Liebig University Giessen, Medical Clinic I, Division of Cardiology, Giessen, Germany
- These authors contributed equally
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