Oxidative Stress and Inflammatory Biomarkers for the Prediction of Severity and ICU Admission in Unselected Patients Hospitalized with COVID-19

Int J Mol Sci. 2021 Jul 12;22(14):7462. doi: 10.3390/ijms22147462.

Abstract

Objective: We aimed to investigate the prognostic performances of oxidative stress (OS), inflammatory and cell activation biomarkers measured at admission in COVID-19 patients.

Design: retrospective monocentric study.

Setting: patients with suspected SARS-CoV-2 infection (COVID-19) admitted to the hospital.

Patients: One hundred and sixty documented and unselected COVID-19-patients. Disease severity (from mild to critical) was scored according to NIH's classification.

Interventions: none.

Measurements and main results: We measured OS biomarkers (thiol, advanced oxidation protein products (AOPP), ischemia-modified albumin (IMA)), inflammation biomarkers (interleukin-6 (IL-6), presepsin) and cellular activation biomarkers (calprotectin) in plasma at admission. Thiol concentrations decreased while IMA, IL-6, calprotectin and PSEP increased with disease severity in COVID-19 patients and were associated with increased O2 needs and ICU admission. The best area under the receiver-operating-characteristics curve (AUC) for the prediction of ICU admission was for thiol (AUC = 0.762). A thiol concentration <154 µmol/L was predictive for ICU admission (79.7% sensitivity, 64.6% specificity, 58.8% positive predictive value, 78.9% negative predictive value). In a stepwise logistic regression, we found that being overweight, having dyspnoea, and thiol and IL-6 plasmatic concentrations were independently associated with ICU admission. In contrast, calprotectin was the best biomarker to predict mortality (AUC = 0.792), with an optimal threshold at 24.1 mg/L (94.1% sensitivity, 64.9% specificity, 97.1% positive predictive value and 98.9% negative predictive value), and survival curves indicated that high IL-6 and calprotectin concentrations were associated with a significantly increased risk of mortality.

Conclusions: Thiol measurement at admission is a promising tool to predict ICU admission in COVID-19-patients, whereas IL-6 and calprotectin measurements effectively predict mortality.

Keywords: COVID-19; SARS-CoV-2; biomarker; inflammation; outcome; oxidative stress; thiol.

MeSH terms

  • Adult
  • Aged
  • Biomarkers / metabolism*
  • COVID-19 / complications
  • COVID-19 / epidemiology*
  • COVID-19 / pathology
  • COVID-19 / virology
  • Critical Care
  • Female
  • Hospitalization / statistics & numerical data*
  • Humans
  • Inflammation / diagnosis*
  • Inflammation / metabolism
  • Inflammation / virology
  • Intensive Care Units
  • Male
  • Middle Aged
  • Oxidative Stress*
  • Prognosis
  • ROC Curve
  • Retrospective Studies
  • SARS-CoV-2 / isolation & purification*
  • Severity of Illness Index*

Substances

  • Biomarkers