MR-proAdrenomedullin as a predictor of renal replacement therapy in a cohort of critically ill patients with COVID-19

About 20% of ICU patients with COVID-19 require renal replacement therapy (RRT). Mid-regional pro-adrenomedullin (MR-proADM) might be used for risk assessment. This study investigates MR-proADM for RRT prediction in ICU patients with COVID-19. We analysed data of consecutive patients with COVID-19, requiring ICU admission at a university hospital in Germany between March and September 2020. Clinical characteristics, details on AKI, and RRT were assessed. MR-proADM was measured on admission. 64 patients were included (49 (77%) males). Median age was 62.5y (54–73). 47 (73%) patients were ventilated and 50 (78%) needed vasopressors. 25 (39%) patients had severe ARDS, and 10 patients needed veno-venous extracorporeal membrane oxygenation. 29 (45%) patients required RRT; median time from admission to RRT start was 2 (1–9) days. MR-proADM on admission was higher in the RRT group (2.491 vs. 1.23 nmol/l; p = 0.002) and showed the highest correlation with renalSOFA. ROC curve analysis showed that MR-proADM predicts RRT with an AUC of 0.69 (95% CI: 0.543–0.828; p = 0.019). In multivariable logistic regression MR-proADM was an independent predictor (OR: 3.813, 95% CI 1.110–13.102, p AKI requiring RRT is frequent in ICU patients with COVID-19. MR-proADM on admission was able to predict RRT requirement, which may be of interest for risk stratification and management.约20%的新冠重症监护病房（ICU）患者需接受肾脏替代治疗（RRT）。肾上腺髓质素前体中段区域（MR-proADM）可用于风险评估。本研究旨在探讨MR-proADM对新冠ICU患者需接受RRT的预测价值。 本研究分析了2020年3月至9月间，德国某大学附属医院收治的、符合新冠ICU收治指征的连续入组患者数据。研究评估了患者的临床特征、急性肾损伤（AKI）相关细节以及RRT使用情况，并于患者入院时检测其MR-proADM水平。 本研究共纳入64例患者，其中男性49例（占比77%），中位年龄为62.5岁（四分位距：54~73岁）。47例（73%）患者接受机械通气，50例（78%）需使用血管活性药物；25例（39%）患者罹患重度急性呼吸窘迫综合征（ARDS），其中10例需接受静脉-静脉体外膜肺氧合（VV-ECMO）治疗。29例（45%）患者最终需接受RRT，从入院至开始RRT的中位时间为2天（四分位距：1~9天）。 需接受RRT的患者入院时MR-proADM水平显著更高（2.491 vs. 1.23 nmol/L；P=0.002），且其与肾脏序贯器官衰竭评分（renalSOFA）的相关性最强。受试者工作特征（ROC）曲线分析显示，MR-proADM预测RRT需求的曲线下面积（AUC）为0.69（95%置信区间：0.543~0.828；P=0.019）。多因素logistic回归分析显示，MR-proADM是独立预测因子（优势比OR：3.813，95%置信区间：1.110~13.102，P[原文未完整标注统计量]）。 需接受RRT的急性肾损伤在新冠ICU患者中较为常见。入院时检测的MR-proADM水平可有效预测患者是否需接受RRT，这一结果或可为患者的风险分层与临床管理提供参考价值。