A Pilot Study on Oxidative Stress during the Recovery Phase in Critical COVID-19 Patients in a Rehabilitation Facility: Potential Utility of the PAOT® Technology for Assessing Total Anti-Oxidative Capacity

Oxidative Stress Markers and Prediction of Severity With a Machine Learning Approach in Hospitalized Patients With COVID-19 and Severe Lung Disease: Observational, Retrospective, Single-Center Feasibility Study

Background

Serious pulmonary pathologies of infectious, viral, or bacterial origin are accompanied by inflammation and an increase in oxidative stress (OS). In these situations, biological measurements of OS are technically difficult to obtain, and their results are difficult to interpret. OS assays that do not require complex preanalytical methods, as well as machine learning methods for improving interpretation of the results, would be very useful tools for medical and care teams.

Objective

We aimed to identify relevant OS biomarkers associated with the severity of hospitalized patients' condition and identify possible correlations between OS biomarkers and the clinical status of hospitalized patients with COVID-19 and severe lung disease at the time of hospital admission.

Methods

All adult patients hospitalized with COVID-19 at the Infirmerie Protestante (Lyon, France) from February 9, 2022, to May 18, 2022, were included, regardless of the care service they used, during the respiratory infectious COVID-19 epidemic. We collected serous biomarkers from the patients (zinc [Zn], copper [Cu], Cu/Zn ratio, selenium, uric acid, high-sensitivity C-reactive protein [hs-CRP], oxidized low-density lipoprotein, glutathione peroxidase, glutathione reductase, and thiols), as well as demographic variables and comorbidities. A support vector machine (SVM) model was used to predict the severity of the patients' condition based on the collected data as a training set.

Results

A total of 28 patients were included: 8 were asymptomatic at admission (grade 0), 14 had mild to moderate symptoms (grade 1) and 6 had severe to critical symptoms (grade 3). As the first outcome, we found that 3 biomarkers of OS were associated with severity (Zn, Cu/Zn ratio, and thiols), especially between grades 0 and 1 and between grades 0 and 2. As a second outcome, we found that the SVM model could predict the level of severity based on a biological analysis of the level of OS, with only 7% misclassification on the training dataset. As an illustrative example, we simulated 3 different biological profiles (named A, B, and C) and submitted them to the SVM model. Profile B had significantly high Zn, low hs-CRP, a low Cu/Zn ratio, and high thiols, corresponding to grade 0. Profile C had low Zn, low selenium, high oxidized low-density lipoprotein, high glutathione peroxidase, a low Cu/Zn ratio, and low glutathione reductase, corresponding to grade 2.

Conclusions

The level of severity of pulmonary damage in patients hospitalized with COVID-19 was predicted using an SVM model; moderate to severe symptoms in patients were associated with low Zn, low plasma thiol, increased hs-CRP, and an increased Cu/Zn ratio among a panel of 10 biomarkers of OS. Since this panel does not require a complex preanalytical method, it can be used and studied in other pathologies associated with OS, such as infectious pathologies or chronic diseases.

Prevalence of dental caries among coronavirus disease 2019-recovered patients and correlation with salivary total antioxidant capacity in Kalaburagi region of Indian subpopulation

Background

Coronavirus disease 2019 (COVID-19) has vastly affected mankind worldwide, and its long-term effect on oral health needs to be studied.

Aims

The aim of the study was to evaluate the prevalence of dental caries and its correlation with salivary total antioxidant capacity (TAC) in Kalaburagi region of the Indian subpopulation.

Methods

About 80 subjects (16-55 years) were included in the study based on selection criteria and were divided into two groups (n = 40). Group 1: no history of COVID-19 infection and Group 2: COVID-19-recovered subjects. Each group was subdivided into two subgroups (n = 20) A and B with and without dental caries. Dental caries was assessed using the decay, missing, filled, treatment (DMFT) index by the World Health Organization. About 5 ml of unstimulated saliva samples was collected and centrifuged at 2000 rpm for 10 min, and the supernatants were collected. Salivary TAC was estimated using 2,2'-azino-bis-[3-ethylbenzothiazoline-6-sulfonic] acid assay and observed under spectrophotometer (734 nm).

Statistical Analysis

Data were analyzed using the Shapiro-Wilk test for normality distribution followed by one-way analysis of variance and post hoc Tukey test (P < 0.05).

Results

COVID-19-recovered subjects showed a higher prevalence of dental caries and lower TAC levels than non-COVID-19 subjects.

Conclusion

Higher prevalence of dental caries with lower levels of salivary TAC was found in COVID-19-recovered individuals.

Alteration of Blood Oxidative Stress Status in Patients with Thoracic Aortic Dissection: A Pilot Study

BACKGROUND

Thoracic aortic dissection (TAD) is a life-threatening condition which usually occurs on an aneurysmal aortic wall. Although increasing data have shown that inflammation and oxidative stress play an important role in the patho-physiology of dissection, systemic oxidative stress status (OSS) has not been clearly determined in patients suffering from TAD.

METHODS

A cohort of 115 patients presenting type A or B TAD were admitted to our center from 2013 to 2017. Out of this cohort, 46 patients were included in a study on dissected aorta (LIege study on DIssected Aorta: LIDIA). In 18 out of the 46 patients, systemic OSS parameters were evaluated after TAD diagnosis by determination of eight different antioxidants, four trace elements, two markers of oxidative lipid damage and two inflammatory markers.

RESULTS

The 18 TAD patients included 10 men and 8 women (median age: 62 years; interquartile range: 55-68) diagnosed with type A (N = 8) or B (N = 10) TAD. Low plasma levels of vitamin C, β-carotene, γ-tocopherol, thiol proteins, paraoxonase and selenium were observed in these 18 patients. By contrast, the concentration of copper and total hydroperoxides, copper/zinc ratio, as well as inflammatory markers, were higher than the reference intervals. No difference was observed in oxidative stress biomarker concentrations between type A and B TAD patients.

CONCLUSIONS

This pilot study, limited to 18 TAD patients, revealed a heightened systemic OSS, determined at 15.5 days (median) after the initial diagnosis, in those TAD patients without complications (malperfusion syndrome and aneurysm formation). Larger studies on biological fluids are needed to better characterize the oxidative stress and interpret its consequence in TAD disease.