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Elevated level of circulating calprotectin correlates with severity and high mortality in patients with COVID-19
Haoran Zhang1, Qingyu Zhang1, Kun Liu2
1Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China.
Insights
Calprotectin (S100A8/S100A9) is elevated in severe COVID-19 cases. This meta-analysis indicates calprotectin is a useful biomarker for distinguishing COVID-19 severity and predicting patient prognosis.
Area of Science:
- Immunology
- Biomarkers
- Infectious Diseases
Background:
- Coronavirus disease-2019 (COVID-19) is associated with hyperinflammation.
- Calprotectin (S100A8/S100A9), a protein secreted by immune cells, has been implicated in COVID-19 severity and prognosis.
Conclusions:
- Calprotectin is significantly elevated in severe COVID-19.
- This protein may serve as a valuable biomarker for assessing COVID-19 severity.
- Calprotectin shows potential for predicting prognosis in COVID-19 patients.
Background:
Patients with coronavirus disease-2019 (COVID-19) are characterized by hyperinflammation. Calprotectin (S100A8/S100A9) is a calcium- and zinc-binding protein mainly secreted by neutrophilic granulocytes or macrophages and has been suggested to be correlated with the severity and prognosis of COVID-19.
Aim:
To thoroughly evaluate the diagnostic and prognostic utility of calprotectin in patients with COVID-19 by analyzing relevant studies.
Methods:
PubMed, Web of Science, and Cochrane Library were comprehensively searched from inception to August 1, 2023 to retrieve studies about the application of calprotectin in COVID-19. Useful data such as the level of calprotectin in different groups and the diagnostic efficacy of this biomarker for severe COVID-19 were extracted and aggregated by using Stata 16.0 software.
Results:
Fifteen studies were brought into this meta-analysis. First, the pooled standardized mean differences (SMDs) were used to estimate the differences in the levels of circulating calprotectin between patients with severe and non-severe COVID-19. The results showed an overall estimate of 1.84 (95% confidence interval [CI]: 1.09-2.60). Diagnostic information was extracted from 11 studies, and the pooled sensitivity and specificity of calprotectin for diagnosing severe COVID-19 were 0.75 (95% CI: 0.64-0.84) and 0.88 (95% CI: 0.79-0.94), respectively. The AUC was 0.89 and the pooled DOR was 18.44 (95% CI: 9.07-37.51). Furthermore, there was a strong correlation between elevated levels of circulating calprotectin and a higher risk of mortality outcomes in COVID-19 patients (odds ratio: 8.60, 95% CI: 2.17-34.12; p < 0.1).
Conclusion:
This meta-analysis showed that calprotectin was elevated in patients with severe COVID-19, and this atypical inflammatory cytokine might serve as a useful biomarker to distinguish the severity of COVID-19 and predict the prognosis.
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