Utility of laboratory and immune biomarkers in predicting disease progression and mortality among patients with moderate to severe COVID-19 disease at a Philippine tertiary hospital.

Autor:	Punzalan FER; Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.; College of Medicine, University of the Philippines Manila, Manila, Philippines., Aherrera JAM; Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.; College of Medicine, University of the Philippines Manila, Manila, Philippines., de Paz-Silava SLM; College of Public Health, University of the Philippines Manila, Manila, Philippines., Mondragon AV; Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.; College of Medicine, University of the Philippines Manila, Manila, Philippines., Malundo AFG; Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.; College of Medicine, University of the Philippines Manila, Manila, Philippines., Tan JJE; Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.; College of Medicine, University of the Philippines Manila, Manila, Philippines., Tantengco OAG; Department of Physiology, College of Medicine, University of the Philippines Manila, Manila, Philippines.; Department of Biology, College of Science, De La Salle University, Manila, Philippines., Quebral EPB; College of Medicine, University of the Philippines Manila, Manila, Philippines., Uy MNAR; Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.; College of Medicine, University of the Philippines Manila, Manila, Philippines., Lintao RCV; College of Medicine, University of the Philippines Manila, Manila, Philippines., Dela Rosa JGL; College of Medicine, University of the Philippines Manila, Manila, Philippines., Mercado MEP; Department of Clinical Epidemiology, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines., Avenilla KC; College of Medicine, University of the Philippines Manila, Manila, Philippines., Poblete JB; Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines., Albay AB Jr; Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.; College of Medicine, University of the Philippines Manila, Manila, Philippines., David-Wang AS; Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.; College of Medicine, University of the Philippines Manila, Manila, Philippines., Alejandria MM; Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.; College of Medicine, University of the Philippines Manila, Manila, Philippines.; Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Manila, Philippines.
Jazyk:	angličtina
Zdroj:	Frontiers in immunology [Front Immunol] 2023 Feb 28; Vol. 14, pp. 1123497. Date of Electronic Publication: 2023 Feb 28 (Print Publication: 2023).
DOI:	10.3389/fimmu.2023.1123497
Abstrakt:	Purpose: This study was performed to determine the clinical biomarkers and cytokines that may be associated with disease progression and in-hospital mortality in a cohort of hospitalized patients with RT-PCR confirmed moderate to severe COVID-19 infection from October 2020 to September 2021, during the first wave of COVID-19 pandemic before the advent of vaccination. Patients and Methods: Clinical profile was obtained from the medical records. Laboratory parameters (complete blood count [CBC], albumin, LDH, CRP, ferritin, D-dimer, and procalcitonin) and serum concentrations of cytokines (IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-18, IFN-γ, IP-10, TNF-α) were measured on Days 0-3, 4-10, 11-14 and beyond Day 14 from the onset of illness. Regression analysis was done to determine the association of the clinical laboratory biomarkers and cytokines with the primary outcomes of disease progression and mortality. ROC curves were generated to determine the predictive performance of the cytokines. Results: We included 400 hospitalized patients with COVID-19 infection, 69% had severe to critical COVID-19 on admission. Disease progression occurred in 139 (35%) patients, while 18% of the total cohort died (73 out of 400). High D-dimer >1 µg/mL (RR 3.5 95%CI 1.83-6.69), elevated LDH >359.5 U/L (RR 1.85 95%CI 1.05-3.25), lymphopenia (RR 1.91 95%CI 1.14-3.19), and hypoalbuminemia (RR 2.67, 95%CI 1.05-6.78) were significantly associated with disease progression. High D-dimer (RR 3.95, 95%CI 1.62-9.61) and high LDH (RR 5.43, 95%CI 2.39-12.37) were also significantly associated with increased risk of in-hospital mortality. Nonsurvivors had significantly higher IP-10 levels at 0 to 3, 4 to 10, and 11 to 14 days from illness onset ( p< 0.01), IL-6 levels at 0 to 3 days of illness ( p =0.03) and IL-18 levels at days 11-14 of illness ( p <0.001) compared to survivors. IP-10 had the best predictive performance for disease progression at days 0-3 (AUC 0.81, 95%CI: 0.68-0.95), followed by IL-6 at 11-14 days of illness (AUC 0.67, 95%CI: 0.61-0.73). IP-10 predicted mortality at 11-14 days of illness (AUC 0.77, 95%CI: 0.70-0.84), and IL-6 beyond 14 days of illness (AUC 0.75, 95%CI: 0.68-0.82). Conclusion: Elevated D-dimer, elevated LDH, lymphopenia and hypoalbuminemia are prognostic markers of disease progression. High IP-10 and IL-6 within the 14 days of illness herald disease progression. Additionally, elevated D-dimer and LDH, high IP-10, IL-6 and IL-18 were also associated with mortality. Timely utilization of these biomarkers can guide clinical monitoring and management decisions for COVID-19 patients in the Philippines. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2023 Punzalan, Aherrera, de Paz-Silava, Mondragon, Malundo, Tan, Tantengco, Quebral, Uy, Lintao, Dela Rosa, Mercado, Avenilla, Poblete, Albay, David-Wang and Alejandria.)
Databáze:	MEDLINE
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