Plasma Levels of Mid-Regional Proadrenomedullin Accurately Identify H1N1pdm09 Influenza Virus Patients with Risk of Intensive Care Admission and Mortality in the Emergency Department

• Published in: Journal of personalized medicine Vol. 12; no. 1; p. 84
• Main Authors: Valenzuela-Méndez, Blanca, Valenzuela-Sánchez, Francisco, Rodríguez-Gutiérrez, Juan Francisco, Bohollo-de-Austria, Rafael, Estella, Ángel, Martínez-García, Pilar, González-García, María Ángela, Rello, Jordi
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 10-01-2022; MDPI
• Subjects: Adrenomedullin; Airway management; Bacterial infections; Biomarkers; Blood tests; C-reactive protein; Diagnostic tests; Emergency medical care; Ferritin; Hospitals; Hypotension; Infections; Infectious diseases; Influenza A; Medical prognosis; Mortality; Pandemics; Patients; Plasma; Plasma levels; Pneumonia; Precision medicine; Procalcitonin; Random variables; Sepsis; Swine flu; Values; Viral infections; Viruses; CRP; H1N1 influenza pneumonia; ferritin; biomarkers; procalcitonin; MR proadrenomedullin; virus; ICU admission; sepsis
• ISSN: 2075-4426; 2075-4426
• DOI: 10.3390/jpm12010084

Early identification of severe viral pneumonia in influenza virus A (H1N1pdm09) patients is extremely important for prompt admission to the ICU. The objective is to evaluate the usefulness of MR-proadrenomedullin (MR-proADM) compared to C reactive protein (CRP), procalcitonin (PCT), and ferritin in the prognosis of influenza A pneumonia. This prospective, observational, multicenter study included one hundred thirteen patients with confirmed influenza virus A (H1N1pdm09) admitted to an Emergency Department and ICUs of six hospitals in Spain. Measurements and Main Results: one-hundred thirteen patients with confirmed influenza virus A (H1N1pdm09) were enrolled. Seventy-five subjects (mortality 29.3%) with severe pneumonia caused by influenza A H1N1pdm09 virus (H1N1vIPN) were compared with 38 controls (CG).The median MR-proADM levels at hospital admission were 1.2 nmol/L (IQR (0.8-2.6) vs. 0.5 nmol/L (IQR 0.2-0.9) in the CG (
= 0.01), and PCT levels were 0.43 μg/L (IQR 0.2-1.2) in the H1N1vIPN group and 0.1 μg/L (IQR 0.1-0.2) in the CG (
< 0.01). CRP levels at admission were 15.5 mg/dL(IQR 9.2-24.9) in H1N1vIPN and 8.6 mg/dL(IQR 3-17.3) in the CG (
< 0.01). Ferritin levels at admission were 558.1 ng/mL(IQR 180-1880) in H1N1vIPN and 167.7 ng/mL(IQR 34.8-292.9) in the CG (
< 0.01). A breakpoint for hospital admission of MR-proADM of 1.1 nmol/L showed a sensitivity of 55% and a specificity of 90% (AUC-ROC0.822). Non-survivors showed higher MR-proADM levels: median of 2.5 nmol/L vs. 0.9 nmol/L among survivors (
< 0.01). PCT, CRP, and ferritin levels also showed significant differences in predicting mortality. The MR-proADM AUC-ROC for mortality was 0.853 (
< 0.01). In a Cox proportional hazards model, MR-proADM levels > 1.2 nmol/L at hospital admission were significant predictive factors for ICU and 90-day mortality (HR: 1.3). Conclusions: the initial MR-proADM, ferritin, CRP, and PCT levels effectively determine adverse outcomes and risk of ICU admission and mortality in patients with influenza virus pneumonia. MR-proADM has the highest potency for survival prediction.