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Measurement of Chitinase Activity in Biological Samples
Published on: August 22, 2019
Chitinase-3-like protein-1 at hospital admission predicts COVID-19 outcome: a prospective cohort study
Rebecca De Lorenzo1,2, Clara Sciorati1, Nicola I Lorè1,3
1Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, San Raffaele Via Olgettina 58, 20132, Milan, Italy.
Insights
Chitinase-3-like protein-1 (CHI3L1) is elevated in patients with Coronavirus 2019 (COVID-19) and predicts severe disease and adverse outcomes. Higher CHI3L1 levels at admission indicate a poorer prognosis for COVID-19 patients.
Area of Science:
- Biochemistry
- Immunology
- Infectious Diseases
Background:
- Chitinase-3-like protein-1 (CHI3L1) is produced in response to infectious and inflammatory stimuli.
- CHI3L1 plays a role in tissue damage, repair, and remodeling processes.
- The predictive value of CHI3L1 in Coronavirus 2019 (COVID-19) prognosis is not well-established.
Purpose of the Study:
- To investigate whether plasma CHI3L1 levels at disease onset can predict the clinical outcome in patients with COVID-19.
- To compare CHI3L1 levels between COVID-19 patients and healthy controls.
- To assess the changes in CHI3L1 levels in survivors post-discharge.
Main Methods:
- Prospective cohort study of 191 COVID-19 patients admitted to the hospital.
- Plasma samples collected at admission for COVID-19 patients and from healthy volunteers.
- Plasma samples collected from survivors one month post-discharge.
- Primary outcome: transfer to intensive care unit (ICU) or death.
- Statistical analyses included Cox regression and Kaplan-Meier curve analysis.
Main Results:
- COVID-19 patients exhibited significantly higher plasma CHI3L1 levels compared to healthy controls (p < 0.0001).
- Patients with unfavorable outcomes (ICU admission or death) had markedly elevated CHI3L1 levels (p < 0.0001).
- Plasma CHI3L1 levels independently predicted adverse outcomes, even after adjusting for clinical factors (p < 0.0001).
- Higher CHI3L1 levels (above median) were associated with a poorer prognosis (log rank test, p < 0.0001).
- CHI3L1 levels decreased in survivors post-discharge but remained elevated compared to controls (p < 0.05).
Conclusions:
- Plasma CHI3L1 is significantly increased in patients with COVID-19.
- Elevated CHI3L1 levels at hospital admission are a strong predictor of adverse clinical outcomes in COVID-19.
- CHI3L1 may serve as a valuable prognostic biomarker for COVID-19 severity.
Abstract:
Infectious and inflammatory stimuli elicit the generation of chitinase-3-like protein-1 (CHI3L1), involved in tissue damage, repair and remodeling. We evaluated whether plasma CHI3L1 at disease onset predicts clinical outcome of patients with Coronavirus 2019 (COVID-19) disease. Blood from 191 prospectively followed COVID-19 patients were collected at hospital admission between March 18th and May 5th, 2020. Plasma from 80 survivors was collected one month post-discharge. Forty age- and sex-matched healthy volunteers served as controls. Primary outcome was transfer to intensive care unit (ICU) or death. CHI3L1 was higher in COVID-19 patients than controls (p < 0.0001). Patients with unfavorable outcome (41 patients admitted to ICU, 47 died) had significantly higher CHI3L1 levels than non-ICU survivors (p < 0.0001). CHI3L1 levels abated in survivors one month post-discharge, regardless of initial disease severity (p < 0.0001), although remaining higher than controls (p < 0.05). Cox regression analysis revealed that CHI3L1 levels predict primary outcome independently of age, sex, comorbidities, degree of respiratory insufficiency and systemic inflammation or time from symptom onset to sampling (p < 0.0001). Kaplan-Meier curve analysis confirmed that patients with CHI3L1 levels above the median (361 ng/mL) had a poorer prognosis (log rank test, p < 0.0001). Plasma CHI3L1 is increased in COVID-19 patients and predicts adverse outcome.
