Biomarkers of inflammation and multisystem tissue and organ damage in patients with COVID-19
Keywords:
biomarkers, COVID 19, inflammation, multisystem damage
Abstract
Objective. The importance of in vitro laboratory diagnostic tests for COVID-19 lies in assessing disease severity, monitoring patients, therapeutic monitoring, and predicting disease prognosis. The aim of our study was to evaluate inflammation biomarkers in COVID-19 patients and their association with biomarkers of cardiomyocyte, liver, and kidney damage, and how they impact disease progression.
Methods. The study included 50 patients, 38 (76%) male and 12 (24%) female, with an average age of 64.38 ± 10.95 years, treated for COVID-19 in 2021 at the Clinic for Infectious Diseases of the University Clinical Center Kragujevac. Biomarkers of inflammation, cardiomyocyte, liver, and kidney damage were analyzed at the beginning of hospitalization and on the tenth day using standard laboratory methods and autoanalyzers.
Results. Analysis showed a significant increase in inflammation parameters on the tenth day of hospitalization compared to initial values: leukocytes (p=0.003), neutrophils (p=0.002), platelets (p<0.001), C-reactive protein (p<0.001), PCT (p=0.011), and IL-6 (p=0.004). Hepatocyte damage biomarkers (ALT (p=0.005), GGT (p=0.033)), and kidney function biomarkers (urea (p<0.001) and creatinine (p=0.042)) also increased significantly. Positive correlations were found between inflammation biomarkers and cardiomyocyte and hepatocyte damage at admission. CRP and PCT concentrations were associated with increased risk of cardiomyocyte damage, while neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) predicted heart and kidney damage.
Conclusion. Systemic inflammation in COVID-19 patients leads to disruptions in body homeostasis, reflected in changes in inflammation biomarkers and multi-system tissue and organ damage. Monitoring these parameters can help predict disease progression and complications.
Key words: biomarkers, COVID 19, inflammation, multisystem damage
References
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2. Barciszewska AM. Elucidating of oxidative distress in COVID-19 and methods of its prevention. Chem Biol Interact. 01. Август 2021.;344:109501.
3. Kumar A, Singh R, Kaur J, Pandey S, Sharma V, Thakur L, и остали. Wuhan to World: The COVID-19 Pandemic. Front Cell Infect Microbiol. 30. Март 2021.;11:596201.
4. Guan W jie, Liang W hua, Zhao Y, Liang H rui, Chen Z sheng, Li Y min, и остали. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J. Мај 2020.;55(5):2000547.
5. Grasselli G, Pesenti A, Cecconi M. Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response. JAMA. 28. Април 2020.;323(16):1545.
6. Van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, и остали. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med. 16. Април 2020.;382(16):1564–7.
7. Ni W, Yang X, Yang D, Bao J, Li R, Xiao Y, и остали. Role of angiotensin-converting enzyme 2 (ACE2) in COVID-19. Crit Care. Децембар 2020.;24(1):422.
8. Beyerstedt S, Casaro EB, Rangel ÉB. COVID-19: angiotensin-converting enzyme 2 (ACE2) expression and tissue susceptibility to SARS-CoV-2 infection. Eur J Clin Microbiol Infect Dis. Мај 2021.;40(5):905–19.
9. Pons MJ, Ymaña B, Mayanga-Herrera A, Sáenz Y, Alvarez-Erviti L, Tapia-Rojas S, и остали. Cytokine Profiles Associated With Worse Prognosis in a Hospitalized Peruvian COVID-19 Cohort. Front Immunol. 01. Септембар 2021.;12:700921.
10. Velikova TV, Miteva L, Stanilov N, Spassova Z, Stanilova SA. Interleukin-6 compared to the other Th17/Treg related cytokines in inflammatory bowel disease and colorectal cancer. WJG. 28. Април 2020.;26(16):1912–25.
11. Li X, Geng M, Peng Y, Meng L, Lu S. Molecular immune pathogenesis and diagnosis of COVID-19. Journal of Pharmaceutical Analysis. Април 2020.;10(2):102–8.
12. Chan JFW, Yuan S, Kok KH, To KKW, Chu H, Yang J, и остали. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. The Lancet. Фебруар 2020.;395(10223):514–23.
13. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, и остали. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 17. Март 2020.;323(11):1061.
14. Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, и остали. Dysregulation of Immune Response in Patients With Coronavirus 2019 (COVID-19) in Wuhan, China. Clinical Infectious Diseases. 28. Јули 2020.;71(15):762–8.
15. Adamo S, Chevrier S, Cervia C, Zurbuchen Y, Raeber ME, Yang L, и остали. Profound dysregulation of T cell homeostasis and function in patients with severe COVID‐19. Allergy. Септембар 2021.;76(9):2866–81.
16. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, и остали. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. Март 2020.;395(10229):1054–62.
17. Sidhwani SK, Mirza T, Khatoon A, Shaikh F, Khan R, Shaikh OA, и остали. Inflammatory markers and COVID-19 disease progression. J Infect Public Health. Септембар 2023.;16(9):1386–91.
18. Yoo EH, Chang SH, Song DY, Lee CH, Cheong GY, Park S, и остали. Comprehensive Laboratory Data Analysis to Predict the Clinical Severity of Coronavirus Disease 2019 in 1,952 Patients in Daegu, Korea. Ann Lab Med. 01. Јануар 2022.;42(1):24–35.
19. AlSamman M, Caggiula A, Ganguli S, Misak M, Pourmand A. Non-respiratory presentations of COVID-19, a clinical review. The American Journal of Emergency Medicine. Новембар 2020.;38(11):2444–54.
20. Kumar-M P, Mishra S, Jha DK, Shukla J, Choudhury A, Mohindra R, и остали. Coronavirus disease (COVID-19) and the liver: a comprehensive systematic review and meta-analysis. Hepatol Int. Септембар 2020.;14(5):711–22.
21. Bowe B, Xie Y, Xu E, Al-Aly Z. Kidney Outcomes in Long COVID. JASN. Новембар 2021.;32(11):2851–62.
22. Alizad G, Ayatollahi AA, Shariati Samani A, Samadizadeh S, Aghcheli B, Rajabi A, и остали. Hematological and Biochemical Laboratory Parameters in COVID-19 Patients: A Retrospective Modeling Study of Severity and Mortality Predictors. Biomed Res Int. 2023.;2023:7753631.
23. World Health Organization. (2020) Laboratory testing strategy recommendations for COVID-19: interim guidance. https://apps. who.int/iris/handle/10665/331509.
24. Kenneth Oh. Aberrant cytokine activity in the host immune response to COVID‑19 leads to cytokine release syndrome. Мај 2020.;
25. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, и остали. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 15. Фебруар 2020.;395(10223):507–13.
26. Chang D, Lin M, Wei L, Xie L, Zhu G, Dela Cruz CS, и остали. Epidemiologic and Clinical Characteristics of Novel Coronavirus Infections Involving 13 Patients Outside Wuhan, China. JAMA. 17. Март 2020.;323(11):1092.
27. Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. Мај 2020.;46(5):846–8.
28. Liu F, Li L, Xu M, Wu J, Luo D, Zhu Y, и остали. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. J Clin Virol. Јуни 2020.;127:104370.
29. Wang L. C-reactive protein levels in the early stage of COVID-19. Médecine et Maladies Infectieuses. Јуни 2020.;50(4):332–4.
30. Lippi G, Plebani M. Procalcitonin in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis. Clin Chim Acta. Јуни 2020.;505:190–1.
31. Chalmers S, Khawaja A, Wieruszewski PM, Gajic O, Odeyemi Y. Diagnosis and treatment of acute pulmonary inflammation in critically ill patients: The role of inflammatory biomarkers. World J Crit Care Med. 11. Септембар 2019.;8(5):59–71.
32. Meng LB, Yu ZM, Guo P, Wang QQ, Qi RM, Shan MJ, и остали. Neutrophils and neutrophil-lymphocyte ratio: Inflammatory markers associated with intimal-media thickness of atherosclerosis. Thrombosis Research. Октобар 2018.;170:45–52.
33. Okugawa Y, Toiyama Y, Yamamoto A, Shigemori T, Ide S, Kitajima T, и остали. Lymphocyte-C-reactive Protein Ratio as Promising New Marker for Predicting Surgical and Oncological Outcomes in Colorectal Cancer. Annals of Surgery. Август 2020.;272(2):342–51.
34. Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HHX, и остали. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. Journal of Infection. Јули 2020.;81(1):e6–12.
35. Cai Q, Huang D, Yu H, Zhu Z, Xia Z, Su Y, и остали. COVID-19: Abnormal liver function tests. Journal of Hepatology. Септембар 2020.;73(3):566–74.
36. Feng G, Zheng KI, Yan QQ, Rios RS, Targher G, Byrne CD, и остали. COVID-19 and Liver Dysfunction: Current Insights and Emergent Therapeutic Strategies. Journal of Clinical and Translational Hepatology. 28. Март 2020.;8(1):1–7.
37. Yang L, Wang W, Wang X, Zhao J, Xiao L, Gui W, и остали. Creg in Hepatocytes Ameliorates Liver Ischemia/Reperfusion Injury in a TAK1‐Dependent Manner in Mice. Hepatology. Јануар 2019.;69(1):294–313.
38. Higuera-de La Tijera F, Servín-Caamaño A, Reyes-Herrera D, Flores-López A, Robiou-Vivero EJA, Martínez-Rivera F, и остали. Impact of liver enzymes on SARS-CoV-2 infection and the severity of clinical course of COVID-19. Liver Research. Март 2021.;5(1):21–7.
39. Pranata R, Huang I, Lim MA, Yonas E, Vania R, Lukito AA, и остали. Elevated De Ritis Ratio Is Associated With Poor Prognosis in COVID-19: A Systematic Review and Meta-Analysis. Front Med. 22. Децембар 2021.;8:676581.
40. Drácz B, Czompa D, Müllner K, Hagymási K, Miheller P, Székely H, и остали. The Elevated De Ritis Ratio on Admission Is Independently Associated with Mortality in COVID-19 Patients. Viruses. 26. Октобар 2022.;14(11):2360.
41. Youssef M, H Hussein M, Attia AS, M Elshazli R, Omar M, Zora G, и остали. COVID‐19 and liver dysfunction: A systematic review and meta‐analysis of retrospective studies. Journal of Medical Virology. Октобар 2020.;92(10):1825–33.
42. Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential Effects of Coronaviruses on the Cardiovascular System: A Review. JAMA Cardiol. 01. Јули 2020.;5(7):831.
43. Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol. Мај 2020.;17(5):259–60.
44. Han Y, Zeng H, Jiang H, Yang Y, Yuan Z, Cheng X, и остали. CSC Expert Consensus on Principles of Clinical Management of Patients With Severe Emergent Cardiovascular Diseases During the COVID-19 Epidemic. Circulation [Интернет]. 19. Мај 2020. [цитирано 07. Новембар 2024.];141(20). Available at: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.047011
45. Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol. Мај 2020.;17(5):259–60.
46. Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, и остали. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 26. Март 2020.;m1091.
47. Khan S, Rasool ST, Ahmed SI. Role of Cardiac Biomarkers in COVID-19: What Recent Investigations Tell Us? Curr Probl Cardiol. Октобар 2021.;46(10):100842.
48. Yaluri N, Stančáková Yaluri A, Žeňuch P, Žeňuchová Z, Tóth Š, Kalanin P. Cardiac Biomarkers and Their Role in Identifying Increased Risk of Cardiovascular Complications in COVID-19 Patients. Diagnostics. 27. Јули 2023.;13(15):2508.
49. Ozturk A, Kara M. Diagnostic and prognostic significance of the lymphocyte/C-reactive protein ratio, neutrophil/lymphocyte ratio, and D-dimer values in patients with COVID-19. BIOCELL. 2022.;46(12):2625–35.
50. Naicker S, Yang CW, Hwang SJ, Liu BC, Chen JH, Jha V. The Novel Coronavirus 2019 epidemic and kidneys. Kidney International. Мај 2020.;97(5):824–8.
51. Pan XW, Xu D, Zhang H, Zhou W, Wang LH, Cui XG. Identification of a potential mechanism of acute kidney injury during the COVID-19 outbreak: a study based on single-cell transcriptome analysis. Intensive Care Med. Јуни 2020.;46(6):1114–6.
52. Han X, Ye Q. Kidney involvement in COVID-19 and its treatments. J Med Virol. Март 2021.;93(3):1387–95.
53. Luo M, Ni K, Sun Y, Guo J, Wen K, Deng L. Toward an optimized strategy of using various airway mucus clearance techniques to treat critically ill COVID-19 patients. BIOCELL. 2022.;46(4):855–71.
54. Zou X, Chen K, Zou J, Han P, Hao J, Han Z. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Front Med. Април 2020.;14(2):185–92.
55. Hirsch JS, Ng JH, Ross DW, Sharma P, Shah HH, Barnett RL, и остали. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int. Јули 2020.;98(1):209–18.
56. Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, и остали. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. Мај 2020.;97(5):829–38.
Published
2025/03/21
Section
Original Scientific Paper