tetano
Editor, Senior Moderator
Front Immunol
. 2023 Mar 21;14:1130821.
doi: 10.3389/fimmu.2023.1130821. eCollection 2023.
Association of SARS-CoV-2 nucleocapsid viral antigen and the receptor for advanced glycation end products with development of severe disease in patients presenting to the emergency department with COVID-19
Zachary A Matthay[SUP] 1 [/SUP], Alexander T Fields[SUP] 1 [/SUP], Katherine D Wick[SUP] 2 3 [/SUP], Chayse Jones[SUP] 2 3 [/SUP], H Clifford Lane[SUP] 4 [/SUP], Kimberly Herrera[SUP] 1 [/SUP], Brenda Nuñez-Garcia[SUP] 1 [/SUP], Efstathios Gennatas[SUP] 5 [/SUP], Carolyn M Hendrickson[SUP] 2 [/SUP], Aaron E Kornblith[SUP] 6 [/SUP], Michael A Matthay[SUP] 2 3 [/SUP], Lucy Z Kornblith[SUP] 1 [/SUP]; COVID-19 Associated Coagulopathy Inflammation Thrombosis (Co-ACIT) Study Group
Collaborators, Affiliations
Abstract
Introduction: There remains a need to better identify patients at highest risk for developing severe Coronavirus Disease 2019 (COVID-19) as additional waves of the pandemic continue to impact hospital systems. We sought to characterize the association of receptor for advanced glycation end products (RAGE), SARS-CoV-2 nucleocapsid viral antigen, and a panel of thromboinflammatory biomarkers with development of severe disease in patients presenting to the emergency department with symptomatic COVID-19.
Methods: Blood samples were collected on arrival from 77 patients with symptomatic COVID-19, and plasma levels of thromboinflammatory biomarkers were measured.
Results: Differences in biomarkers between those who did and did not develop severe disease or death 7 days after presentation were analyzed. After adjustment for multiple comparisons, RAGE, SARS-CoV-2 nucleocapsid viral antigen, interleukin (IL)-6, IL-10 and tumor necrosis factor receptor (TNFR)-1 were significantly elevated in the group who developed severe disease (all p<0.05). In a multivariable regression model, RAGE and SARS-CoV-2 nucleocapsid viral antigen remained significant risk factors for development of severe disease (both p<0.05), and each had sensitivity and specificity >80% on cut-point analysis.
Discussion: Elevated RAGE and SARS-CoV-2 nucleocapsid viral antigen on emergency department presentation are strongly associated with development of severe disease at 7 days. These findings are of clinical relevance for patient prognostication and triage as hospital systems continue to be overwhelmed. Further studies are warranted to determine the feasibility and utility of point-of care measurements of these biomarkers in the emergency department setting to improve patient prognostication and triage.
Keywords: COVID-19; biomarkers; receptor for advanced glycation end products; thromboinflammation; triage.
. 2023 Mar 21;14:1130821.
doi: 10.3389/fimmu.2023.1130821. eCollection 2023.
Association of SARS-CoV-2 nucleocapsid viral antigen and the receptor for advanced glycation end products with development of severe disease in patients presenting to the emergency department with COVID-19
Zachary A Matthay[SUP] 1 [/SUP], Alexander T Fields[SUP] 1 [/SUP], Katherine D Wick[SUP] 2 3 [/SUP], Chayse Jones[SUP] 2 3 [/SUP], H Clifford Lane[SUP] 4 [/SUP], Kimberly Herrera[SUP] 1 [/SUP], Brenda Nuñez-Garcia[SUP] 1 [/SUP], Efstathios Gennatas[SUP] 5 [/SUP], Carolyn M Hendrickson[SUP] 2 [/SUP], Aaron E Kornblith[SUP] 6 [/SUP], Michael A Matthay[SUP] 2 3 [/SUP], Lucy Z Kornblith[SUP] 1 [/SUP]; COVID-19 Associated Coagulopathy Inflammation Thrombosis (Co-ACIT) Study Group
Collaborators, Affiliations
- PMID: 37026003
- PMCID: PMC10070743
- DOI: 10.3389/fimmu.2023.1130821
Abstract
Introduction: There remains a need to better identify patients at highest risk for developing severe Coronavirus Disease 2019 (COVID-19) as additional waves of the pandemic continue to impact hospital systems. We sought to characterize the association of receptor for advanced glycation end products (RAGE), SARS-CoV-2 nucleocapsid viral antigen, and a panel of thromboinflammatory biomarkers with development of severe disease in patients presenting to the emergency department with symptomatic COVID-19.
Methods: Blood samples were collected on arrival from 77 patients with symptomatic COVID-19, and plasma levels of thromboinflammatory biomarkers were measured.
Results: Differences in biomarkers between those who did and did not develop severe disease or death 7 days after presentation were analyzed. After adjustment for multiple comparisons, RAGE, SARS-CoV-2 nucleocapsid viral antigen, interleukin (IL)-6, IL-10 and tumor necrosis factor receptor (TNFR)-1 were significantly elevated in the group who developed severe disease (all p<0.05). In a multivariable regression model, RAGE and SARS-CoV-2 nucleocapsid viral antigen remained significant risk factors for development of severe disease (both p<0.05), and each had sensitivity and specificity >80% on cut-point analysis.
Discussion: Elevated RAGE and SARS-CoV-2 nucleocapsid viral antigen on emergency department presentation are strongly associated with development of severe disease at 7 days. These findings are of clinical relevance for patient prognostication and triage as hospital systems continue to be overwhelmed. Further studies are warranted to determine the feasibility and utility of point-of care measurements of these biomarkers in the emergency department setting to improve patient prognostication and triage.
Keywords: COVID-19; biomarkers; receptor for advanced glycation end products; thromboinflammation; triage.