RNA-expression of adrenomedullin is increased in patients with severe COVID-19
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RESEARCH LETTER
Open Access
RNA-expression of adrenomedullin is increased in patients with severe COVID-19 Julian Hupf1*† , Julian Mustroph2†, Frank Hanses1,3, Katja Evert4, Lars S. Maier2† and Carsten G. Jungbauer2† Adrenomedullin (ADM) is a peptide hormone with vasodilatory effects and involved in the regulation of the endothelial barrier function. Previous research found increased ADM plasma levels in patients with sepsis and ADM levels correlated with disease severity and mortality in sepsis [1]. Although severe coronavirus disease (COVID-19) shares some clinical features of sepsis (e.g., endothelial barrier dysfunction [2]), it is not known whether pathophysiological pathways of COVID-19 resemble those of sepsis [2, 3]. To our knowledge, this is the first study to evaluate ADM in context of COVID-19 [4]. We present here data regarding ADM in patients with COVID-19. Starting from March 2020, we included 45 adult patients presenting with signs of respiratory infection (cough and/or fever) to the Emergency Department in this ongoing study. The study was approved by the ethics committee of the University of Regensburg. Each individual provided written informed consent prior to inclusion. SARSCoV-2 infection status was evaluated by PCR analysis mainly using throat rinse water (or less frequently nasopharyngeal swabs). Patients were classified as COVID-19 positive (PCR positive for SARS-CoV-2 and signs of respiratory infection) or control (other viral or bacterial respiratory infection). Whole blood was drawn by venipuncture and lysed in Trifast (Ambion) buffer solution. Further, RNA expression analysis of ADM in whole blood was performed using qPCR and normalized to GAPDH as housekeeper * Correspondence: [email protected] † Julian Hupf and Julian Mustroph contributed equally to this publication as first authors † Lars S. Maier and Carsten G. Jungbauer contributed equally to this publication as last authors 1 Emergency Department, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany Full list of author information is available at the end of the article
gene. The final diagnosis after patient discharge was reviewed by a consultant physician and patients without evidence of respiratory infection were excluded from analysis (n = 5). Baseline characteristics of the study population are described in Table 1. The risk of clinical deterioration estimated by NEWS-2 Score [5] did not differ between both groups. Six patients in the COVID-19 group were admitted to the ICU (defined as “severe COVID-19”), four of them required mechanical ventilation during hospital stay and three of them died due to COVID-19 or related complications. In contrast, only one patient in the control group died from pneumonia. ADM expression was significantly elevated in patients with COVID-19 than other respiratory infections (Fig. 1a) despite similar clinical features at admission. In patients with COVID-19, ADM expression was significantly higher in patients with severe COVID-19 than in patients with less sever
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