Key Inflammatory biomarkers as COVID-19 severity predictors
Key Inflammatory biomarkers as COVID-19 severity predictors
Shiva Ansari Astaneh,1Nassim Valivand,2Shima Bidabad,3Ali Abdi,4Hajie Lotfi,5,*
1. 1 Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran 2 Department of medical biotechnology, School of paramedical sciences, Qazvin University of Medical Sciences, Qazvin, Iran 2. 1 Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran 2 Department of medical biotechnology, School of paramedical sciences, Qazvin University of Medical Sciences, Qazvin, Iran 3. 1 Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran 2 Department of medical biotechnology, School of paramedical sciences, Qazvin University of Medical Sciences, Qazvin, Iran 4. Istanbul University, Aziz Sancar Experimental Medicine Research Institute, Department of Immunology, Istanbul, Turkey 5. Cellular and Molecular Research Center, Research Institute for prevention of Non-Communicable Disease, Qazvin University of Medical Sciences, Qazvin, Iran
Introduction: The ongoing global pandemic of Covid-19 (Coronavirus disease 19) caused by SARS-CoV-2 infection, has caused severe disruptions in the economy and healthcare systems in every country. The clinical spectrum of SARS-CoV-2 infection is broad. Most COVID-19 patients exhibited mild or moderate disease and almost 15% of patients showed severity status. It was found that 5% of patients were led to critical conditions with various complications such as pneumonia, multiple organ failure, acute respiratory distress syndrome associated with dysregulated immune response, systemic inflammation, and cytokine storm. The management of patients depends on early identification and hospitalization, risk classification, and selection of appropriate treatments. Identification of laboratory markers or biomarkers can promise the rapid prediction of disease severity which significantly affects patient care. Biomarkers are biochemical substances that can be used to objectively measure the presence and severity of disease and drug responses to a therapeutic intervention. In addition, help to decrease the risk of mortality. In this study, a number of immunological and inflammatory biomarkers are discussed that could guide the treatment of COVID-19 patients.
Methods: We navigated the literature search using the terms of "COVID-19" and "inflammatory biomarkers" in the databases (PubMed, Scopus, Science Direct, and ProQuest) until September 1, 2022. A total of 14 studies from 20 articles were included in this review.
Results: Several studies have recognized increased neutrophilia, lymphopenia, T-helper (CD4+) and T-cytotoxic (CD8+) lymphocyte depletion, and neutrophil: lymphocyte ratio (NLR) as biomarkers to prognosis the disease severity. Moreover, interleukin-6 as cytokine secreted by stimulated monocytes and macrophages-and other pro-inflammatory cytokines (TNFα, G-CSF, GMCSF, IL-1β, IL-2, IL-8, IL-17, IP-10, MCP-1and CCL3,) are significantly increased in severely COVID-19 patients. The higher serum C-reactive protein (CRP), a non-specific acute-phase protein induced by IL-6 in the liver, and procalcitonin (PCT) levels (the precursor of calcitonin), which is typically synthesized and released by thyroid parafollicular C cell, are susceptible to progress the disease severity stages. Another risk factor for COVID-19 severity is a high level of ferritin. Also, it has been shown that impaired type I IFN responses (non-IFN or low-level production) and exaggerated type I IFN responses should be associated with the severity of COVID-19 infection.
Conclusion: In the pandemic of Covid-19, biomarkers as measurable indicators could provide acknowledgment of pathological processes to early recognize disease severity and choose the appropriate treatment strategies. Some laboratory biomarkers including neutrophilia, lymphopenia, elevated CRP, PCT, ferritin, pro-inflammatory cytokines especially IL-6 and TNFα and impaired type I IFN response are significantly associated with inflammatory response. These biomarkers could be used as personalized treatment based on patient responses. Future prospective trials could be demonstrated how the treatment protocols based on these biomarkers may affect the consequence of viral infection severity.