Association of Inflammatory Markers with COVID-19 Outcome among Hospitalized Patients: Experience from a Tertiary Healthcare Center in Western India

Proteomic Profiling of COVID-19 Patients Sera: Differential Expression with Varying Disease Stage and Potential Biomarkers

Background/Objectives: SARS-CoV-2 is one of the viruses that caused worldwide health issues. This effect is mainly due to the wide range of disease prognoses it can cause. The aim of this study is to determine protein profiles that can be used as potential biomarkers for patients' stratification, as well as potential targets for drug development. Methods: Eighty peripheral blood samples were collected from heathy as well as SARS-CoV-2 patients admitted at a major tertiary care center in Riyadh, Saudi Arabia. A label-free quantitative mass spectrometry-based proteomic analysis was conducted on the extracted sera. Protein-protein interactions and functional annotations of identified proteins were performed using the STRING. Results: In total, two-hundred-eighty-eight proteins were dysregulated among all four categories. Dysregulated proteins were mainly involved in the network map of SARS-CoV-2, immune responses, complement activation, and lipid transport. Compared to healthy subjects, the most common upregulated protein in all three categories were CRP, LGALS3BP, SAA2, as well as others involved in SARS-CoV-2 pathways such as ZAP70 and IGLL1. Notably, we found fifteen proteins that significantly discriminate between healthy/recovered subjects and moderate/under medication patients, among which are the SERPINA7, HSPD1 and TTC41P proteins. These proteins were also significantly downregulated in under medication versus moderate patients. Conclusions: Our results emphasize the possible association of specific proteins with the SARS-CoV-2 pathogenesis and their potential use as disease biomarkers and drug targets. Our study also gave insights about specific proteins that are likely increased upon infection but are likely restored post recovery.

SARS-CoV-2 Infection-Dependent Modulation in Vital Components of the Serum Profile of Severely SARS-CoV-2 Infected Patients

Background

COVID-19 modulates many serological biomarkers during the progress of disease severity. The study aimed to determine COVID-19 severity-associated perturbance in the serum profile.

Methods

A retrospective study including COVID-19-positive individuals (n = 405) was accomplished. The serum profile of COVID-19 participants was mined from laboratory records. Severity-associated alteration in the serum profile was evaluated using Pearson correlation, regression, VCramer, Bayesian posterior VCramer, and bias factor using R-base-RStudio-version-3.3.0 with a significant cut-off of p < 0.05.

Results

Significantly different mean ± standard deviation (SD) (highly versus moderately severe) of C-reactive protein (CRP), ferritin, neutrophil-lymphocyte ratio (NLR), D-dimer, platelets, prothrombin time (PT), partial prothrombin time (PTT), troponin 1, lactate dehydrogenase (LDH), aspartate-aminotransferase (AST), alanine aminotransferase (ALT), and AST/ALT ratio was observed (p < 0.001). Highly severe COVID-19 associated with CRP, ferritin, NLR, in D-dimer, PT, PTT, troponin 1, AST/ALT ratio, AST and ALT (adjusted odds ratio (AOR): 1.346, 1.05, 1.46, 1.33, 1.42, 1.23, 4.07, 3.9, 1.24, 1.45, p < 0.001). CRP with ferritin (r = 0.743), NLR (r = 0.77), white blood cells (WBC) (r = 0.8), troponin1 with LDH (r = 0.757), and D-dimer with platelets (r = -0.81) were highly correlated. X2pearson (p < 0.001), VCramer (0.71), Bayesian-VCramer (0.7), and bias-factor (-125) for troponin 1 indicate the strong association of troponin 1 level and with COVID-19 severity. X2pearson (p < 0.001), VCramer (1), Bayesian-VCramer (0.98), and bias-factor (-266.3) for NLR exhibited a very strong association of pathologic conditions with the high severity of the disease.

Conclusion

These biomarkers of inflammation (CRP, Ferritin, NLR), coagulation disorders (D-dimer, PT, and PTT) cardiac abnormality (troponin 1), and liver injury (AST/ALT) could be crucial in low-medical resource settings as potential prognosticator/predictors of the COVID-19 severity and clinical outcomes. Moreover, the outcome of this study could be leveraged for the early prediction of disease severity during SARS-CoV or Middle East Respiratory Coronavirus (MERS-CoV) infection.

Vascular risk factors for COVID-19 ARDS: endothelium, contact-kinin system

SARS-CoV-2 binds to ACE2 receptors, expressed within the lungs. Risk factors for hospitalization include hypertension, diabetes, ischaemic heart disease and obesity-conditions linked by the presence of endothelial pathology. Viral infection in this setting causes increased conversion of circulating Factor XII to its active form (FXIIa). This is the first step in the contact-kinin pathway, leading to synchronous activation of the intrinsic coagulation cascade and the plasma Kallikrein-Kinin system, resulting in clotting and inflammatory lung disease. Temporal trends are evident from blood results of hospitalized patients. In the first week of symptoms the activated partial thromboplastin time (APTT) is prolonged. This can occur when clotting factors are consumed as part of the contact (intrinsic) pathway. Platelet counts initially fall, reflecting their consumption in coagulation. Lymphopenia occurs after approximately 1 week, reflecting the emergence of a lymphocytic pneumonitis [COVID-19 acute respiratory distress syndrome (ARDS)]. Intrinsic coagulation also induces the contact-kinin pathway of inflammation. A major product of this pathway, bradykinin causes oedema with ground glass opacities (GGO) on imaging in early COVID-19. Bradykinin also causes release of the pleiotrophic cytokine IL-6, which causes lymphocyte recruitment. Thromobosis and lymphocytic pneumonitis are hallmark features of COVID-19 ARDS. In this review we examine the literature with particular reference to the contact-kinin pathway. Measurements of platelets, lymphocytes and APTT should be undertaken in severe infections to stratify for risk of developing ARDS.

Clinical and Inflammatory Profile of COVID-19 Infection at a Tertiary Care Centre in Northern Part of Tamil Nadu - A Retrospective Study

Introduction The coronavirus disease (COVID-19) pandemic has incurred high costs for the entire planet. The complex interactions between the host, virus, and environment have resulted in various clinical outcomes. It is crucial to comprehend sickness severity and outcome predictors to provide early preventative measures for a better outcome. The current study aimed to determine the association of clinical and inflammatory profiles with the outcome of COVID-19 infection in patients admitted to the intensive care unit. Methods This retrospective study was done in patients admitted to intensive care units for COVID-19 with a positive reverse transcriptase polymerase chain reaction (RTPCR) assay. A total of 125 patients above 18 years were included in the study. The patient's age, gender, and co-morbidities like type 2 diabetes mellitus, hypertension, respiratory illness, and coronary artery disease were noted. The patient's symptomatology, vital signs, oxygen saturation (Spo2), need for inotropes, and non-invasive positive pressure ventilator support (NIPPV) were observed. Computed tomography severity score (CTSS) and hematological and inflammatory parameters at the time of admission were noticed. Patient's management and treatment outcomes as survivors and non-survivors were noted. Results The mean age was significantly greater in non-survivors. The common symptoms were fever, respiratory distress, cough, muscle pain, and sore throat. The leucocyte count, C-reactive protein (CRP), urea, creatinine, interleukin-6 (IL-6), and lactate dehydrogenase (LDH) were greater, and platelet counts were lower significantly in the non-survivors group. On multivariable logistic regression, CT severity score, NIPPV, and IL-6 had an odds ratio of 1.17, 0.052, and 1.03, respectively. IL-6 had a sensitivity of 81.5% and a specificity of 81.8% with a cut-off value of 37.5. Conclusion Vigilant monitoring of leucocyte count, CRP, urea, creatinine, IL-6, LDH, platelet count, and CT severity score is essential for managing COVID-19 infection. IL-6 was found to be a significant marker as a predictor of outcome in our study.

Risk Assessment of COVID-19 Infection among the Elderly Population

Introduction:Elderly patients are susceptible to COVID-19 infection. They usually present with atypical symptoms and multiple organ dysfunction. The poor outcome in elderly patients is due to multiple comorbidities, declining functional status, and frailty. This study aimed to assess the risk profile of COVID-19 infection in the elderly population. Materials and methods:Patients aged 60 years and above with COVID-19 positive by RT-PCR were included in the study. Patients' demographic data, co-morbidities and severity of illness, complete hemogram, blood sugar, renal, liver function test, lactate dehydrogenase, interleukin-6, ferritin, D-dimer were noted. Patients' outcome in terms of survival was observed. Results:The total count, neutrophil lymphocyte ratio, ESR, urea, creatinine, interleukin 6, D-dimer, and blood sugar value were significantly associated with non-survival even after adjustment for age and gender. Complications such as acute kidney injury (AKI), renal failure, acute respiratory distress syndrome, multiorgan dysfunction syndrome (MODS), and World Health Organization (WHO) severity were also associated with non-survival before and after adjustment for age and gender. On Cox regression survival analysis, . three co-morbidities had hazard ratio (HR) of 54.36 [95% CI 3.66 to 807.01], WHO severity had HR of 31.09 [95% CI 1.31 to 738.22], MODS had HR of 16.97 [95% CI 2.86 to 100.39], creatinine had HR of 8.44 [95% CI 1.99 to 35.77], AKI had HR of 6.71 [95% CI 1.11 to 40.56]. Conclusion:In elderly patients with COVID-19 infection, the presence of at least three co-morbidities, severity of infection by WHO criteria and presence of complications such as MODS, elevated creatinine and AKI were predictors of the survival rate and mortality.