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

Abstract

Background

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.

Methods

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.

Results

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<0.05) for RRT requirement.

Conclusion

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.

Keywords:

• COVID-19
• multiple organ failure
• intensive care unit
• SARS-COV-2
• acute kidney injury
• renal replacement therapy
• MR-proADM

Acknowledgements

We sincerely thank the study nurses of the Department of Intensive Care Medicine involved in data acquisition and management – Grit Ringeis, Melanie Kerinn, Lisa Krebs, and Andrea Conrad.

Ethics approval and informed consent

The Ethics Committee of the Hamburg Chamber of Physicians was informed about the study (No.: WF-117/20). The need for informed consent had been waived. The study complied with the Declaration of Helsinki.

Author contributions

AN, KR, DJ and SK conceived and designed the study. KR and DJ, MH, MF, OB, MK, GdH, CB, DF and BS were involved in data acquisition and laboratory analysis. MF, KR, DJ and AN analysed and interpreted the data. KR, DJ, MF and AN drafted the manuscript. AN, MF and SK critically revised the manuscript for important intellectual content. All authors read and approved the final manuscript.

Disclosure statement

KR, MF, DJ, MH, OB, BS and CB do not report any conflicts of interest. SK received research support by Ambu, E.T.View Ltd, Fisher & Paykel, Pfizer and Xenios, lecture honoraria from ArjoHuntleigh, Astellas, Astra, Basilea, Bard, Baxter, Biotest, CSL Behring, CytoSorbents, Fresenius, Gilead, MSD, Orion, Pfizer, Philips, Sedana, Sorin, Xenios and Zoll, and consultant honorarium from AMOMED, Astellas, Baxter, Bayer, Fresenius, Gilead, MSD, Pfizer and Xenios. AN received research funds, lecture honoraria and travel reimbursement within the last 5 years from CytoSorbents Europe, Biotest AG and ThermoFisher Scientific. MK reports grant support from Adrenomed and Vifor, and honoraria within the last 5 years from Adrenomed, Sphingotec, Vifor, Amgen, Bayer, 4TEEN4, Astra-Zeneca, Roche Diagnostics, and Sanofi. DF reports lecture honoraria within the last 5 years from Xenios AG. All other authors report no conflict of interest.

Data availability statement

The datasets supporting the conclusions of this article are available upon reasonable request.

Additional information

Funding

This study was supported exclusively by institutional funds of the Department of Intensive Care Medicine.