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Updated: Aug 16, 2025
On-Chip Endothelial Inflammatory Phenotyping
Published on: July 21, 2012
Endothelial Monocyte-Activating Polypeptide-II Is an Indicator of Severity and Mortality in COVID-19 Patients
Manal Mohamed Saber1, Azhar Mohamed Nomair2, Ashraf M Osman1
1Department of Clinical Pathology, Faculty of Medicine, Minia University, Minia 61519, Egypt.
Abstract:
Data for predicting the severity and mortality of coronavirus disease 2019 (COVID-19) are limited, and investigations are ongoing. Endothelial monocyte-activating protein II (EMAP-II) is a multifunctional polypeptide with pro-inflammatory properties. EMAP-II is a significant pathogenic component in chronic inflammatory lung diseases and lung injury. In this study, we aimed to assess the potential utility of EMAP-II as a predictor of COVID-19 severity and mortality. This study included 20 healthy volunteers and 60 verified COVID-19 patients. Nasopharyngeal samples from COVID-19-positive subjects and normal volunteers were collected at admission. The nasopharyngeal samples were subjected to EMAP-II real-time polymerase chain reaction (RT-PCR). EMAP-II RNA was not detected in nasopharyngeal swabs of normal controls and mild to asymptomatic COVID-19 patients and was only detectable in severe COVID-19 patients. EMAP-II critical threshold (Ct) was positively associated with lymphocyte percentages and oxygen saturation (p < 0.001) while being negatively associated with age (p = 0.041), serum CRP, ferritin, and D-dimer levels (p < 0.001). EMAP-II Ct cutoff ≤34 predicted a worse outcome in COVID-19 illness, with a sensitivity and specificity of 100%. Our study suggests that EMAP-II could be considered a potential biomarker of COVID-19 severity. EMAP-II can predict the fatal outcome in COVID-19 patients.
Insights
Endothelial monocyte-activating protein II (EMAP-II) is a potential biomarker for predicting coronavirus disease 2019 (COVID-19) severity. EMAP-II was detected only in severe COVID-19 cases, indicating its utility in assessing patient outcomes.
Area of Science:
- Biochemistry
- Immunology
- Infectious Diseases
Background:
- Predicting coronavirus disease 2019 (COVID-19) severity and mortality remains challenging.
- Endothelial monocyte-activating protein II (EMAP-II), a pro-inflammatory polypeptide, is implicated in lung injury and chronic inflammatory lung diseases.
Purpose of the Study:
- To evaluate the potential of EMAP-II as a biomarker for predicting COVID-19 severity and mortality.
- To assess the correlation between EMAP-II levels and clinical parameters in COVID-19 patients.
Main Methods:
- Real-time polymerase chain reaction (RT-PCR) was used to detect EMAP-II RNA in nasopharyngeal samples.
- The study included 20 healthy volunteers and 60 COVID-19 patients (mild, asymptomatic, and severe cases).
- Statistical analysis correlated EMAP-II critical threshold (Ct) values with clinical and laboratory findings.
Main Results:
- EMAP-II RNA was detected exclusively in severe COVID-19 patients, not in healthy controls or those with mild/asymptomatic disease.
- Lower EMAP-II Ct values (indicating higher expression) were associated with older age, lower lymphocyte percentages, reduced oxygen saturation, and elevated CRP, ferritin, and D-dimer levels.
- An EMAP-II Ct cutoff of ≤34 demonstrated 100% sensitivity and specificity in predicting worse outcomes in COVID-19 patients.
Conclusions:
- EMAP-II shows significant potential as a biomarker for predicting COVID-19 severity.
- Detection of EMAP-II in nasopharyngeal samples may aid in identifying patients at high risk for fatal outcomes.
