1
|
Sweet DR, Freeman ML, Zidar DA. Immunohematologic Biomarkers in COVID-19: Insights into Pathogenesis, Prognosis, and Prevention. Pathog Immun 2023; 8:17-50. [PMID: 37427016 PMCID: PMC10324469 DOI: 10.20411/pai.v8i1.572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/24/2023] [Indexed: 07/11/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has had profound effects on the health of individuals and on healthcare systems worldwide. While healthcare workers on the frontlines have fought to quell multiple waves of infection, the efforts of the larger research community have changed the arch of this pandemic as well. This review will focus on biomarker discovery and other efforts to identify features that predict outcomes, and in so doing, identify possible effector and passenger mechanisms of adverse outcomes. Identifying measurable soluble factors, cell-types, and clinical parameters that predict a patient's disease course will have a legacy for the study of immunologic responses, especially stimuli, which induce an overactive, yet ineffectual immune system. As prognostic biomarkers were identified, some have served to represent pathways of therapeutic interest in clinical trials. The pandemic conditions have created urgency for accelerated target identification and validation. Collectively, these COVID-19 studies of biomarkers, disease outcomes, and therapeutic efficacy have revealed that immunologic systems and responses to stimuli are more heterogeneous than previously assumed. Understanding the genetic and acquired features that mediate divergent immunologic outcomes in response to this global exposure is ongoing and will ultimately improve our preparedness for future pandemics, as well as impact preventive approaches to other immunologic diseases.
Collapse
Affiliation(s)
- David R. Sweet
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Michael L. Freeman
- Division of Infectious Diseases and HIV Medicine, Case Western Reserve University, Cleveland, OH
| | - David A. Zidar
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
- Cardiology Section, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH
- Center for Global Health and Diseases, Department of Pathology, Case Western Reserve University School of Medicine, Case Western Reserve University, Cleveland, OH
| |
Collapse
|
2
|
Zerbato V, Sanson G, De Luca M, Di Bella S, di Masi A, Caironi P, Marini B, Ippodrino R, Luzzati R. The Impact of Serum Albumin Levels on COVID-19 Mortality. Infect Dis Rep 2022; 14:278-286. [PMID: 35645213 PMCID: PMC9149867 DOI: 10.3390/idr14030034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/07/2022] [Accepted: 04/14/2022] [Indexed: 12/22/2022] Open
Abstract
Low serum albumin (SA) correlates with mortality in critically ill patients, including those with COVID-19. We aimed to identify SA thresholds to predict the risk of longer hospital stay, severe respiratory failure, and death in hospitalized adult patients with COVID-19 pneumonia. A prospective longitudinal study was conducted at the Infectious Diseases Unit of Trieste University Hospital (Italy) between March 2020 and June 2021. The evaluated outcomes were: (1) need of invasive mechanical ventilation (IMV); (2) length of hospital stay (LOS); and (3) 90-day mortality rate. We enrolled 864 patients. Hypoalbuminemia (<3.5 g/dL) was detected in 586 patients (67.8%). SA on admission was significantly lower in patients who underwent IMV (2.9 vs. 3.4 g/dL; p < 0.001). The optimal SA cutoff predicting the need of IMV was 3.17 g/dL (AUC 0.688; 95% CI: 0.618−0.759; p < 0.001) and this threshold appeared as an independent risk factor for the risk of IMV in multivariate Cox regression analysis. The median LOS was 12 days and a higher SA was predictive for a shorter LOS (p < 0.001). The overall 90-day mortality rate was 15%. SA was significantly lower in patients who died within 90 days from hospital admission (3.1 g/dL; IQR 2.8−3.4; p < 0.001) as compared to those who survived (3.4 g/dL; IQR 3.1−3.7). The optimal SA threshold predicting high risk of 90-day mortality was 3.23 g/dL (AUC 0.678; 95% CI: 0.629−0.734; p < 0.001). In a multivariate Cox regression analysis, SA of <3.23 g/dL appeared to be an independent risk factor for 90-day mortality. Our results suggest that low SA on admission may identify patients with COVID-19 pneumonia at higher risk of severe respiratory failure, death, and longer LOS. Clinicians could consider 3.2 g/dL as a prognostic threshold for both IMV and mortality in hospitalized COVID-19 patients.
Collapse
Affiliation(s)
- Verena Zerbato
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), 34125 Trieste, Italy;
| | - Gianfranco Sanson
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, 34149 Trieste, Italy; (G.S.); (R.L.)
| | - Marina De Luca
- Operative Unit of Medicina Clinica, Trieste University Hospital (ASUGI), 34125 Trieste, Italy;
| | - Stefano Di Bella
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, 34149 Trieste, Italy; (G.S.); (R.L.)
- Correspondence:
| | | | - Pietro Caironi
- Department of Anaesthesia and Critical Care, AOU S. Luigi Gonzaga, Department of Oncology, University of Turin, 10043 Turin, Italy;
| | - Bruna Marini
- Ulisse BioMed Labs, Area Science Park, SS 14, km 163.5, 34149 Trieste, Italy; (B.M.); (R.I.)
| | - Rudy Ippodrino
- Ulisse BioMed Labs, Area Science Park, SS 14, km 163.5, 34149 Trieste, Italy; (B.M.); (R.I.)
| | - Roberto Luzzati
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, 34149 Trieste, Italy; (G.S.); (R.L.)
| |
Collapse
|
3
|
Lang LW, Zhu ZZ, Xu Z, Zhu SW, Meng P, Wang HY, Song ZD, Wang Y, Bi JF. The Association Between the Albumin and Viral Negative Conversion Rate in Patients Infected with Novel Coronavirus Disease 2019 (COVID-19). Infect Drug Resist 2022; 15:1687-1694. [PMID: 35422642 PMCID: PMC9005238 DOI: 10.2147/idr.s353091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/03/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The novel coronavirus disease 2019 (COVID-19) epidemic is the severe global pandemic with large numbers of infected cases and deaths in recent decades. The previous studies were all about the influence of albumin (ALB) for the severity and mortality of in-patients infected with COVID-19. But few studies exist about the influence factors to achieve viral negative conversion. Therefore, this study conducted an exploratory study to investigate the effect of albumin on negative conversion rate. Methods Among the 190 hospitalized patients with moderate COVID-19 who had a course of disease longer than 30 days, 102 achieved viral negative conversion in 30–45 days and 88 not after 45 days. Taking other variables as concomitant variable, Cox proportional hazard regression model was applied to explore the influence of albumin to negative conversion rate under various factors. Results By comparing patients who could and could not achieve the finally viral negative conversion, a possible nonlinear relationship between the continuous variables and clinical outcomes was examined by a restricted cubic spline regression model. An association was found between albumin levels and hazard ratio of viral negative conversion rate (P = 0.027). The increase of albumin was accompanied with decreases of hazard ratio of viral negative conversion rate (the value of albumin <38 g/L). But when the value of albumin was higher than 38 g/L, the hazard ratio of viral negative conversion rate approached 1, it means that albumin is not a risk factor for the viral negative conversion rate of COVID-19 disease. Conclusion For patients with COVID-19, albumin is a common and observed laboratory parameter. It is associated with final viral negative conversion rate although its underlying mechanism and relationship with the viral negative conversion rate still need to be clarified.
Collapse
Affiliation(s)
- Li-wei Lang
- Clinical Trial Research Center, Department of Pharmacy, Medical Supplies Center of PLA General Hospital, Beijing, 100039, People’s Republic of China
| | - Zhen-zhen Zhu
- Clinical Trial Research Center, Department of Pharmacy, Medical Supplies Center of PLA General Hospital, Beijing, 100039, People’s Republic of China
| | - Zhe Xu
- Department of Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, 100039, People’s Republic of China
| | - Shan-wei Zhu
- Clinical Trial Research Center, Department of Pharmacy, Medical Supplies Center of PLA General Hospital, Beijing, 100039, People’s Republic of China
| | - Peng Meng
- Department of Outpatient, Zi-Bo Central Hospital of Shan Dong, Shan Dong, 255036, People’s Republic of China
| | - Hong-yan Wang
- Clinical Trial Research Center, Department of Pharmacy, Medical Supplies Center of PLA General Hospital, Beijing, 100039, People’s Republic of China
| | - Zhan-dong Song
- Clinical Trial Research Center, Department of Pharmacy, Medical Supplies Center of PLA General Hospital, Beijing, 100039, People’s Republic of China
| | - Ying Wang
- Respiratory Department No. 960 Hospital, The People’s Liberation Army, Jinan, 250014, People’s Republic of China
- Ying Wang, Respiratory Department No. 960 Hospital, The People’s Liberation Army, Jinan, 250014, People’s Republic of China, Email
| | - Jing-feng Bi
- Clinical Trial Research Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, People’s Republic of China
- Correspondence: Jing-feng Bi, Clinical Trial Research Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, People’s Republic of China, Email
| |
Collapse
|
4
|
van Zyl JS, Felius J, Alam A, Hall SA, Jamil AK, Spak CW, Gottlieb RL. Dynamic albumin values as clinical surrogate for COVID-19 therapeutics. J Investig Med 2021; 69:1260. [PMID: 34050000 PMCID: PMC8172265 DOI: 10.1136/jim-2021-001895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Johanna S van Zyl
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas, USA
- Texas A&M University Health Science Center, Dallas, Texas, USA
| | - Joost Felius
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas, USA
- Texas A&M University Health Science Center, Dallas, Texas, USA
| | - Amit Alam
- Texas A&M University Health Science Center, Dallas, Texas, USA
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA
- Division of Cardiology, Baylor University Medical Center, Dallas, TX, USA
| | - Shelley A Hall
- Texas A&M University Health Science Center, Dallas, Texas, USA
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA
- Division of Cardiology, Baylor University Medical Center, Dallas, TX, USA
| | - Aayla K Jamil
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas, USA
- Texas A&M University Health Science Center, Dallas, Texas, USA
| | - Cedric W Spak
- Division of Infectious Disease, Baylor University Medical Center, Dallas, Texas, USA
- Texas Centers for Infectious Disease Associates, Dallas, Texas, USA
| | - Robert L Gottlieb
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas, USA
- Texas A&M University Health Science Center, Dallas, Texas, USA
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA
- Division of Cardiology, Baylor University Medical Center, Dallas, TX, USA
- Division of Precision Medicine, Baylor University Medical Center, Dallas, TX, USA
| |
Collapse
|
5
|
Batth SK. Correlation of rate of serum albumin decline with other acute phase reactants and effect of current treatment options on serum albumin level in COVID-19. J Investig Med 2021; 69:1259. [PMID: 34050001 PMCID: PMC8172261 DOI: 10.1136/jim-2021-001881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 11/06/2022]
|