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Elevated NET, Calprotectin, and Neopterin Levels Discriminate between Disease Activity in COVID-19, as Evidenced by
Geir Hetland1,2, Magne Kristoffer Fagerhol1,2, Mohammad Reza Mirlashari1
1Department of Immunology and Transfusion Medicine, Oslo University Hospital Ullevål, 0450 Oslo, Norway.
Insights
Biomarkers like calprotectin and neutrophil extracellular traps (NETs) can help identify COVID-19 patients at higher risk of hospitalization. These inflammatory markers, along with neopterin, show promise in early disease assessment.
Area of Science:
- Immunology
- Infectious Diseases
- Biochemistry
Background:
- Coronavirus disease 2019 (COVID-19) exhibits varied clinical presentations.
- Limited data exists on early or mild disease, hindering risk stratification.
- Identifying early biomarkers for hospitalization risk is crucial for patient management.
Purpose of the Study:
- To characterize potential biomarkers for discriminating hospitalization risk in COVID-19 patients.
- To investigate inflammatory markers in mild versus severe disease during the early pandemic wave.
- To assess the utility of specific biomarkers in predicting disease severity.
Main Methods:
- Enrolled 76 symptomatic SARS-CoV-2 positive patients and controls.
- Measured plasma levels of soluble C5b-9/C5a, neutrophil extracellular traps (NETs), calprotectin, DNase, and proinflammatory cytokines.
- Analyzed biomarkers in hospitalized versus non-hospitalized patient groups.
Main Results:
- Calprotectin and NET levels effectively differentiated hospitalized from non-hospitalized patients.
- Neopterin levels increased early in disease, with higher levels in hospitalized patients.
- Calprotectin, NETs, and neopterin showed correlations with each other and other inflammatory markers.
Conclusions:
- Calprotectin, NETs, and neopterin are significant proinflammatory parameters.
- These biomarkers show potential for discriminating COVID-19 patients at risk of hospitalization.
- Early assessment of these markers could aid in clinical decision-making for mild/early COVID-19.
Abstract:
Coronavirus disease 2019 (COVID-19) displays clinical heterogeneity, but little information is available for patients with mild or very early disease. We aimed to characterize biomarkers that are useful for discriminating the hospitalization risk in a COVID-19 cohort from Northern Italy during the first pandemic wave. We enrolled and followed for four weeks 76 symptomatic SARS-CoV-2 positive patients and age/sex-matched healthy controls. Patients with mild disease were discharged (n.42), and the remaining patients were hospitalized (n.34). Blood was collected before any anti-inflammatory/immunosuppressive therapy and assessed for soluble C5b-9/C5a, H3-neutrophil extracellular traps (NETs), calprotectin, and DNase plasma levels via ELISA and a panel of proinflammatory cytokines via ELLA. Calprotectin and NET levels discriminate between hospitalized and non-hospitalized patients, while DNase negatively correlates with NET levels; there are positive correlations between calprotectin and both NET and neopterin levels. Neopterin levels increase in patients at the beginning of the disease and do so more in hospitalized than non-hospitalized patients. C5a and sC5b-9, and other acute phase proteins, correlate with neopterin, calprotectin, and DNase. Both NET and neopterin levels negatively correlate with platelet count. We show that calprotectin, NETs, and neopterin are important proinflammatory parameters potentially useful for discriminating between COVID-19 patients at risk of hospitalization.
