RT journal article
T1 Plasma Levels of Mid-Regional Proadrenomedullin Accurately Identify H1N1pdm09 Influenza Virus Patients with Risk of Intensive Care Admission and Mortality in the Emergency Department
A1 Valenzuela-Méndez, Blanca
A1 Valenzuela-Sánchez, Francisco
A1 Rodríguez‑Gutiérrez, Juan Francisco
A1 Bohollo-de-Austria, Rafael
A1 Estella García, Ángel
A1 Martínez-García, Pilar
A1 González-García, María Ángela
A1 Rello, Jordi
A2 Medicina
K1 H1N1 influenza pneumonia
K1 biomarkers
K1 MR proadrenomedullin
K1 procalcitonin
K1 ferritin
K1 CRP
K1 sepsis
K1 virus
K1 ICU admission
AB 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 mu g/L (IQR 0.2-1.2) in the H1N1vIPN group and 0.1 mu 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.
PB MDPI
SN 2075-4426
YR 2022
FD 2022-01
LK http://hdl.handle.net/10498/26547
UL http://hdl.handle.net/10498/26547
LA eng
DS Repositorio Institucional de la Universidad de Cádiz
RD 13-nov-2026