884f9c5de6cd1bcc098fc435de26f951 pmc_35055399.pdf dc3efaf2f5c7b54f7bb0297a38741166ad87294f pmc_35055399.pdf 6ca0b1839c993eab3be50b1f15345f45bd1d5776c8960953469e7445a9a320e2 pmc_35055399.pdf Title: Plasma Levels of Mid-Regional Proadrenomedullin Accurately Identify H1N1pdm09 Influenza Virus Patients with Riskof Intensive Care Admission and Mortality in the Emergency Department Subject: 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 (p = 0.01), and PCT levels were 0.43 g/L (IQR 0.2–1.2) in the H1N1vIPN group and 0.1 g/L (IQR 0.1–0.2) in the CG (p < 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 (p < 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 (p < 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 (p < 0.01). PCT, CRP, and ferritin levels also showed significant differences in predicting mortality. The MR-proADM AUC-ROC for mortality was 0.853 (p < 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. Keywords: H1N1 influenza pneumonia; biomarkers; MR proadrenomedullin; procalcitonin; ferritin; CRP; sepsis; virus; ICU admission Author: Blanca Valenzuela-Méndez, Francisco Valenzuela-Sánchez, Juan Francisco Rodríguez-Gutiérrez, Rafael Bohollo-de-Austria, Ángel Estella, Pilar Martínez-García, María Ángela González-García and Jordi Rello Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Mon Jan 10 10:29:06 2022 CET ModDate: Mon Jan 10 10:32:25 2022 CET Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 14 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1990213 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- HCRKXL+VnURWPalladioL Type 1 Custom yes yes no 10 0 OVNEXW+EURM10 Type 1 Builtin yes yes no 15 0 URZTAM+URWPalladioL-Bold Type 1 Custom yes yes no 19 0 NVDZQN+URWPalladioL-Roma Type 1 Custom yes yes no 24 0 JYJZBM+URWPalladioL-Ital Type 1 Custom yes yes no 28 0 ILUGHX+VnURWPalladioL-Bold Type 1 Custom yes yes no 32 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 40 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 44 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 48 0 UIJACC+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 60 0 BSDWLC+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 63 0 RQPVQI+CMSY10 Type 1 Builtin yes yes no 85 0 URYLRZ+URWPalladioL-BoldItal Type 1 Custom yes yes no 98 0 CRUZTT+VnURWPalladioL-Italic Type 1 Custom yes yes no 139 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2023-03-25 02:30:33 CET RepresentationInformation: pmc_35055399.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2022-01-31 03:36:33 CET Size: 1990213 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 309 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@44c8afef Item: Title: Materials and Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7b69c6ba Item: Title: Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@46daef40 Item: Title: Discussion Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@12f41634 Item: Title: Conclusions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@13c27452 Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@262b2c86 Info: Title: Plasma Levels of Mid-Regional Proadrenomedullin Accurately Identify H1N1pdm09 Influenza Virus Patients with Riskof Intensive Care Admission and Mortality in the Emergency Department Author: Blanca Valenzuela-Méndez, Francisco Valenzuela-Sánchez, Juan Francisco Rodríguez-Gutiérrez, Rafael Bohollo-de-Austria, Ángel Estella, Pilar Martínez-García, María Ángela González-García and Jordi Rello Subject: 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 (p = 0.01), and PCT levels were 0.43 g/L (IQR 0.2 1.2) in the H1N1vIPN group and 0.1 g/L (IQR 0.1 0.2) in the CG (p < 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 (p < 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 (p < 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 (p < 0.01). PCT, CRP, and ferritin levels also showed significant differences in predicting mortality. The MR-proADM AUC-ROC for mortality was 0.853 (p < 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. 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