Stratification of hypertension and SARS-CoV-2 infection by quantitative NMR spectroscopy of human blood serum

Jasmin Kazenwadel; Georgy Berezhnoy; Claire Cannet; Hartmut Schäfer; Tobias Geisler; Anne-Katrin Rohlfing; Meinrad Gawaz; Uta Merle; Christoph Trautwein

doi:10.1038/s43856-023-00365-y

Stratification of hypertension and SARS-CoV-2 infection by quantitative NMR spectroscopy of human blood serum

Commun Med (Lond). 2023 Oct 16;3(1):145. doi: 10.1038/s43856-023-00365-y.

Authors

Affiliations

¹ Werner Siemens Imaging Center, Department for Preclinical Imaging and Radiopharmacy, Eberhard Karls University Tübingen, Tübingen, Germany.
² Bruker BioSpin GmbH, Applied Industrial and Clinical Division, Ettlingen, Germany.
³ Department of Internal Medicine III, Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany.
⁴ Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany.
⁵ Werner Siemens Imaging Center, Department for Preclinical Imaging and Radiopharmacy, Eberhard Karls University Tübingen, Tübingen, Germany. Christoph.Trautwein@med.uni-tuebingen.de.

^# Contributed equally.

Abstract

Background: Diagnostic approaches like the nuclear magnetic resonance spectroscopy (NMR) based quantification of metabolites, lipoproteins, and inflammation markers has helped to identify typical alterations in the blood serum of COVID-19 patients. However, confounders such as sex, and comorbidities, which strongly influence the metabolome, were often not considered. Therefore, the aim of this NMR study was to consider sex, as well as arterial hypertension (AHT), when investigating COVID-19-positive serum samples in a large age-and sex matched cohort.

Methods: NMR serum data from 329 COVID-19 patients were compared with 305 healthy controls. 134 COVID-19 patients were affected by AHT. These were analyzed together with NMR data from 58 hypertensives without COVID-19. In addition to metabolite, lipoprotein, and glycoprotein data from NMR, common laboratory parameters were considered. Sex was considered in detail for all comparisons.

Results: Here, we show that several differences emerge from previous NMR COVID-19 studies when AHT is considered. Especially, the previously described triglyceride-rich lipoprotein profile is no longer observed in COVID-19 patients, nor an increase in ketone bodies. Further alterations are a decrease in glutamine, leucine, isoleucine, and lysine, citric acid, HDL-4 particles, and total cholesterol. Additionally, hypertensive COVID-19 patients show higher inflammatory NMR parameters than normotensive patients.

Conclusions: We present a more precise picture of COVID-19 blood serum parameters. Accordingly, considering sex and comorbidities should be included in future metabolomics studies for improved and refined patient stratification. Due to metabolic similarities with other viral infections, these results can be applied to other respiratory diseases in the future.

Plain language summary

The functionality of our human body is driven by a large number of small molecules, called metabolites. These metabolites can be associated with health but also disease conditions. In this study, we used a technology called nuclear magnetic resonance spectroscopy (NMR) to determine metabolite and protein concentrations in the blood of acutely-infected COVID-19 patients and compared these results with disease severity and clinical laboratory data. We particularly focus on patients with the very common cardiovascular condition, arterial hypertension (AHT), and important factors such as sex, age and medication. Our findings provide a more detailed insight into COVID-19 and which individuals are at higher risk for more severe disease.