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This study evaluated the ability of mid-regional proadrenomedullin (MR-proADM) to identify disease severity in Coronavirus disease 2019 (COVID-19) patients in comparison to conventional inflammatory biomarkers and clinical scores.In an observational trial, COVID-19 acute respiratory distress syndrome (ARDS) patients were enrolled. MR-proADM, C-reactive protein (CRP), procalcitonin (PCT) and lactic acid (LA) were measured in all patients at admission (T0), at 24 hours (T1) and in the third (T3) and fifth day (T5) of hospitalization. The aims of this study were to determine the role of MR-proADM to detect patients with high risk of mortality and compare the prognostic value of MR-proADM with commonly used clinical scores (Sequential Organ Failure Assessment score - SOFA score, Acute Physiologic Assessment and Chronic Health Evaluation II score - APACHE II score, and Simplified Acute Physiological score II - SAPS II score).Twenty-one COVID-19 ARDS patients admitted to the Intermediate Care Unit (IMCU) were enrolled. The median MR-proADM values were 2.28, 2.41, 1.96 and 1.89 nmol/L at T0, T1, T3 and T5, respectively. The 30-day all-cause mortality rate was 52.4%. Mean MR-proADM T0 value was significantly higher in non-survivors compared with survivors (3.5 vs. 1.1 nmol/L, p0.05). No significant differences were found for the other inflammatory biomarkers. In terms of the area under the receiver-operating characteristic curve (AUC), MR-proADM showed a similar discriminatory power compared with APACHE II, SOFA and SAPS II score (0.81, 0.91, 0.70 and 0.78, respectively). The optimal MR-proADM cut-point cut-off point was 1.07 nmol/L, which corresponds to a sensitivity of 91% and a specificity of 71%.MR-proADM, in addition to the clinical scores, could be useful to predict outcome in COVID-19 ARDS patients.

Chest pain is one of the most frequent presenting complaints among patients arriving to the Emergency Department. In this population, the prevalence of acute coronary syndrome is about 25% instead that of acute myocardial infarction ranges from 5 to 15%. The diagnostic challenge for the emergency physician is the early rule-in or rule out of acute myocardial infarction within first few hours after chest pain presentation, particularly in those patients with normal or not significant electrocardiogram.The current review is based on an analysis of most important clinical trials on this topic.The universal current guidelines established that the term "myocardial infarction" should be used when there is evidence of myocardial necrosis of ischemic origin, as documented by an increase of myocardial necrosis markers. Actually, cardiac troponins are considered the standard biomarkers for acute myocardial infarction diagnosis, because are more superior in sensitivity and specificity to the other available markers.More recently, high sensitive troponin assays have been developed, permitting the early measurement of very low concentrations.In this review, we analyzed the diagnostic and prognostic significance of these new high sensitive troponins in Emergency Department chest pain management.