Predictive Value of MR-proADM in the Risk Stratification of COVID-19 Patients Assessed at the Triage of the Emergency Department
Authors: Minieri Marilena , Lecce Vito N. Di , Lia Maria Stella , Maurici Massimo , Leonardis Francesca , Longo Susanna , Colangeli Luca , Paganelli Carla , Levantesi Stefania , Terrinoni Alessandro , Malagnino Vincenzo , Brunetti Domenico Junior , Giovannelli Alfredo , Pieri Massimo , Ciotti Marco , D’Agostini Cartesio , Gabriele Mariachiara , Bernardini Sergio , Legramante Jacopo Maria 
Published: November 2021

Abstract
Background

In the last two pandemic years, the Emergency Departments (ED) have been overrun with COVID-19 suspicious patients, creating a pressing need to optimize resources through risk stratification for those patients. For this reason, the assessment of prognostic tools and biomarkers have been necessary. Some dataon the role played by laboratory biomarkers in the early risk stratification of COVID-19 patients have been recently published. The aim of this study is to assess the potential role of the new biomarker mid-regional proadrenomedullim (MR-proADM) in stratifying the in-hospital mortality risk of COVID-19 patients at the triage in order to help the emergency physician in the decision-making process. A further goal of the present study is to evaluate whether MR-proADM together with other biochemical markers could play a key role in assessing the correct care level of these patients by predicting who could need intensive care and ventilation.
Methods

Data from 321 consecutive patients admitted to the triage of the emergency department with a COVID-19 infection were analyzed. Epidemiological, demographic, clinical, laboratory, and outcome data were assessed. C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), d-dimer and MR-proADM blood levels were also evaluated.
Results

All the biomarkers evaluated showed significant increased values at admission in the emergency department in non-survivorsvs survivors as well in ventilated as compared to non-ventilated patients. Moreover, all the biomarkers analyzed showed animportant role in predicting mortality, need of invasive mechanical ventilation (IMV) and non-invasive mechanical ventilation (NIMV) in patients admitted at the emergency department with COVID-19 infection as analyzed by the univariate Cox regression analysis. Pooling together both clinical and laboratory variables in a multivariate analysis, all biomarkers, except for PCT, seem to play a significant role in the mortality risk stratification at admission in the emergency department. Similarly, an increase of MR-proADM level at ED admission resulted independently associated with a threefold times higher risk of IMV. LDH showed a smaller but still significant power. CRP only showed a significant predictive value for the need of NIMV. In patients COVID-19 positive, MR-proADM assessed at the admission in the triage showed a good discriminative performance both for in-hospital mortality (AUC 0,85) and for prediction of IMV (AUC 0,81), whereas it was less effective for NIMV prediction (AUC 0,71). ROC curves and AUC resulted significantly greater for MR-proADM as compared to other laboratory biomarkers for the primary endpoint, i.e. in-hospital mortality, with the exception of CRP.
Conclusion

This study shows that MR-proADM seems to be particularly effective for early predicting mortality and the need of ventilation in COVID-19 patients admitted to the emergency department.