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Association between serum amyloid A levels and predicting disase severity in COVID-19 patients: a systematic review
1Division of Clinical Microbiology, Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China. taochuanmin@scum.edu.cn.
Insights
Serum amyloid A (SAA) levels are significantly higher in severe COVID-19 cases compared to mild cases. Critical COVID-19 patients also show elevated SAA levels, suggesting SAA as a potential biomarker for disease severity.
Area of Science:
- Biochemistry
- Immunology
- Infectious Diseases
Background:
- The COVID-19 pandemic has strained global health resources since December 2019.
- Clinical reports suggest a link between serum amyloid A (SAA) levels and COVID-19 severity.
- A comprehensive synthesis of existing findings on SAA and COVID-19 severity is lacking.
Purpose of the Study:
- To systematically review the role of SAA levels in differentiating between mild, severe, and critical COVID-19.
- To analyze the association of SAA levels with COVID-19 severity.
- To evaluate SAA as a potential biomarker for COVID-19 patient stratification.
Main Methods:
- A systematic literature search was performed in PubMed, Embase, and Web of Science databases up to February 1, 2021.
- Nineteen studies involving 1806 mild cases and 1529 severe cases were included in the meta-analysis.
- Random-effects models were used to compute pooled standardized mean differences (SMDs) and confidence intervals (CIs).
Main Results:
- Patients with severe COVID-19 exhibited significantly higher SAA levels compared to those with mild COVID-19 (SMD=1.155, 95% CI 0.89, 1.42).
- Subgroup analysis indicated that SAA level differences were associated with age, sample size, and detection methods.
- SAA levels were also significantly higher in critical COVID-19 patients than in severe cases (SMD=0.476, 95% CI 0.13, 0.82).
Conclusions:
- Elevated circulating SAA levels are strongly associated with increased COVID-19 severity, particularly in individuals under 50.
- SAA concentrations are significantly higher in critical COVID-19 cases compared to severe cases.
- Further large-scale studies are warranted to confirm SAA's utility in distinguishing COVID-19 patient outcomes.
Objective:
Global health resources have faced huge challenges from the pandemic coronavirus disease 2019 (COVID-19) since December 2019. Numerous clinical reports have focused on the association of serum amyloid A (SAA) levels with severe COVID-19. However, a systematic analysis synthesizing these findings has not been performed. This meta-analysis aims to systematically review the role of SAA levels in distinguishing among patients with mild, severe, and critical COVID-19.
Materials And Methods:
A comprehensive literature search was conducted in the PubMed, Embase, and Web of Science databases from the beginning of the COVID-19 outbreak to February 1, 2021. Two investigators independently reviewed suitable studies. Pooled standardized mean differences (SMDs), 95% confidence intervals (CIs), and correlation coefficients (r) were computed using a random-effects model.
Results:
We included 19 of 317 titles identified by our search, involving a total of 1806 mild cases and 1529 severe cases. Compared with the mild group, the severe group had markedly higher SAA levels (SMD=1.155, 95% CI 0.89, 1.42). Subgroup analysis revealed that the SAA level differences between the severe group and the mild group were associated with age, sample size, and detection method. Sensitivity analyses showed the credibility and robustness of our results. In addition, in six studies involving 1144 patients with severe COVID-19 and 433 patients with critical COVID-19, SAA was significantly higher in patients with critical COVID-19 (SMD=0.476, 95% CI 0.13, 0.82).
Conclusions:
High circulating SAA levels were markedly associated with COVID-19 severity, especially for subjects aged less than 50 years, compared with patients with mild COVID-19. SAA concentrations were also significantly higher in patients with critical COVID-19 compared with those with severe COVID-19. Further studies in large cohorts are needed to confirm whether the SAA is a useful tool in discriminating among patients with stable COVID-19, those with acute exacerbations, and subjects without disease.
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