Several Biomarkers Predict Progression of SARS-CoV-2 Infection

After two years into the pandemic, COVID-19 still poses an imminent global threat. Although most infections remain asymptomatic or cause only mild symptoms, severe cases are still causing significant morbidity and mortality.

On the basis of current knowledge, hyperinflammation plays a critical role in disease progression and clinical deterioration, suggesting that measurements of immune-based biomarkers represent promising tools for the early detection of the likelihood to deteriorate. These parameters can be available within minutes through point-of-care testing, and the insights provided by immune biomarkers might facilitate and accelerate diagnostic work-up.

Medical Microbiologists at Saarland University (Homburg, Germany) recruited into a study 132 patients (mean age 64 years, 40.2% females) who had a polymerase chain reaction (PCR)–confirmed infection with SARS-CoV-2 (except for controls) during the second and third pandemic wave experienced in Germany (December 2020 to July 2021). The control group consisted of 27 adults (mean age 47.1 years, range 22-83; 19 [70.4%] females), composed of 19 adults in group 1 and eight adults in group 2. Nasopharyngeal swabs, blood samples, and SARS-CoV-2 RT-PCR were routinely performed on admission and regularly throughout the hospital stay to account for dynamic changes in biomarker levels over time.

The investigators used a novel platform MeMed Key (MeMed, Tirat Carmel, Israel) that measures the circulating levels of the three host response immune proteins: TNF-related apoptosis-inducing ligand (TRAIL), interferon gamma-induced protein-10 (IP-10), and C-reactive protein (CRP). The method is based on a chemiluminescent immunoassay. Levels of TRAIL, IP-10, and CRP were measured at the study site in serum samples.

The scientists performed a total of 899 measurements. Among patients with COVID-19, TRAIL levels were significantly lower (49.5 versus 87 pg/mL), whereas IP-10 and CRP showed significantly higher levels (667.5 versus 127 pg/mL), and 75.3 versus 1.6 mg/L) than healthy controls. TRAIL yielded an inverse correlation with length of hospital and intensive care unit (ICU) stay, Simplified Acute Physiology Score II, and National Early Warning Score, and IP-10 showed a positive correlation with disease severity. Multivariable regression revealed that obesity (adjusted odds ratio [aOR] 5.434), CRP (aOR 1.014), and peak IP-10 (aOR 1.001) were independent predictors of in-ICU mortality.

The authors concluded that TRAIL and IP-10 showed significant correlation with COVID-19 severity, and CRP and IP-10 levels were associated with adverse COVID-19 outcomes. This suggests that the inclusion of these markers into multivariable risk assessment models could be a promising tool in the management of patients with COVID-19. The study was published on September 1, 2022 in the International Journal of Infectious Diseases.

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