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Mid-regional proadrenomedullin (MR-proADM), C-reactive protein (CRP) and other biomarkers in the early identification of disease progression in patients with COVID-19 in the acute NHS setting
  1. Nathan Moore1,
  2. Rebecca Williams1,
  3. Matilde Mori2,
  4. Beatrice Bertolusso3,
  5. Gabrielle Vernet4,
  6. Jessica Lynch1,
  7. Pete Philipson5,
  8. Thomas Ledgerwood1,
  9. Stephen P Kidd1,
  10. Claire Thomas1,2,
  11. Veronica Garcia-Arias1,
  12. Michelle Young6,
  13. Kordo Saeed2,7,
  14. Kirsty Gordon8,
  15. Nicholas Cortes1,2
  1. 1 Microbiology Department, Basingstoke and North Hampshire Hospital, Basingstoke, UK
  2. 2 Faculty of Medicine, University of Southampton, Southampton, UK
  3. 3 Intensive Care, Basingstoke and North Hampshire Hospital, Basingstoke, UK
  4. 4 Emergency Department, Basingstoke and North Hampshire Hospital, Basingstoke, UK
  5. 5 University of Newcastle upon Tyne, Newcastle upon Tyne, Tyne and Wear, UK
  6. 6 Biochemsitry Department, Whittington Hospital, London, UK
  7. 7 University Hospital Southampton NHS Foundation Trust, Southampton, UK
  8. 8 Biochemistry Department, Basingstoke and North Hampshire Hospital, Basingstoke, UK
  1. Correspondence to Dr Nathan Moore, Basingstoke and North Hampshire Hospital, Basingstoke, UK; nathan.moore{at}


Aims There is a lack of biomarkers validated for assessing clinical deterioration in patients with COVID-19 on presentation to secondary or tertiary care. This evaluation looked at the potential clinical application of C reactive protein (CRP), procalcitonin, mid-regional proadrenomedullin (MR-proADM) and white cell count to support prediction of clinical outcomes.

Methods 135 patients presenting to Hampshire Hospitals NHS Foundation Trust between April and June 2020 confirmed to have COVID-19 via reverse-transcription-qPCR were included. Biomarkers from within 24 hours of presentation were used to predict disease progression by Cox regression and area under the receiver operating characteristic curves. The endpoints assessed were 30-day all-cause mortality, intubation and ventilation, critical care admission and non-invasive ventilation (NIV) use.

Results Elevated MR-proADM was shown to have the greatest ability to predict 30-day mortality adjusting for age, cardiovascular disease, renal disease and neurological disease. A significant association was also noted between raised MR-proADM and CRP concentrations and the requirement for critical care admission and NIV.

Conclusions The measurement of MR-proADM and CRP in patients with confirmed COVID-19 infection on admission shows significant potential to support clinicians in identifying those at increased risk of disease progression and need for higher level care, subsequently enabling prompt escalation in clinical interventions.

  • biochemistry
  • blood proteins
  • COVID-19
  • infections
  • microbiology

Data availability statement

Data are available upon reasonable request for up to 3 years after publication.

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Data availability statement

Data are available upon reasonable request for up to 3 years after publication.

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  • NM and RW are joint first authors.

  • Handling editor Tony Mazzulli.

  • Contributors NM, MY, KG and NC contributed to the study conception and design. Material preparation was performed by TL. Data collection was performed by RW, MM, BB, GV and JL. Data were verified by RW, MM and GV. Analysis was performed by NM and PP. The first draft of the manuscript was written by NM. Authors RW, SPK, CT, VG-A, KS, KG and NC commented on previous versions of the manuscript. NC is responsible for the overall content as the guarantor. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests PP received payment from Thermo Fisher and KS has received research grants from Pfizer and Thermo Fisher. However, neither the payment for PP nor the research grants for KS had any role in study conception, the collection, management, analysis or interpretation of the data, in preparation, review or approval of the manuscript or in the decision to submit the manuscript for publication.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.