Journal Article

Comparison of Different Vascular Biomarkers for Predicting In-Hospital Mortality in Severe SARS-CoV-2 Infection

Kappelmayer, János, Kalina, Edit, Fejes, Zsolt, Szentkereszty, Zoltán, Fagyas, Miklós, Nagy Jr, Béla, Pócsi, Marianna, Sütő, Renáta

2024

Overview

Severe SARS-CoV-2 elicits a hyper-inflammatory response that results in intravascular inflammation with endothelial injury, which contributes to increased mortality in COVID-19. To predict the outcome of severe SARS-CoV-2 infection, we analyzed the baseline level of different biomarkers of vascular disorders in COVID-19 subjects upon intensive care unit (ICU) admission and prior to any vaccination. A total of 70 severe COVID-19 patients (37 survivors and 33 non-survivors) were included with 16 age- and sex-matched controls. Vascular dysfunction was monitored via soluble VCAM-1, E-selectin, ACE2 and Lp-PLA2, while abnormal platelet activation was evaluated by soluble P-selectin and CD40L in parallel. These results were correlated with routine laboratory parameters and disease outcomes. Among these parameters, VCAM-1 and ACE2 showed significantly higher serum levels in COVID-19 patients with early death vs. convalescent subjects. VCAM-1 was significantly correlated with the Horowitz index (r = 0.3115) and IL-6 (r = 0.4599), while ACE2 was related to E-selectin (r = 0.4143) and CD40L (r = 0.2948). Lp-PLA2 was altered in none of these COVID-19 subcohorts and showed no relationship with the other parameters. Finally, the pre-treatment level of VCAM-1 (≥1420 ng/mL) and ACE2 activity (≥45.2 μU/mL) predicted a larger risk for mortality (Log-Rank p = 0.0031 and p = 0.0117, respectively). Vascular dysfunction with endothelial cell activation is linked to lethal COVID-19, and highly elevated soluble VCAM-1 and ACE2 at admission to ICU may predict unfavorable outcomes.

• Publisher: MDPI AG,MDPI
• Subject: ACE2 / Angiotensin-converting enzyme 2 / Autoimmune diseases / Biological markers / Biomarkers / Blood / Blood platelets / blood serum / Cardiovascular disease / CD40L protein / Cell activation / Cholesterol / Comparative analysis / COVID-19 / COVID-19 disease / COVID-19 infection / death / E-selectin / Endothelial cells / endothelial dysfunction / Endothelium / Enzymes / Health aspects / Hematology / Infections / Inflammation / Inflammatory response / Intensive care / interleukin-6 / intravascular inflammation / Laboratories / Mortality / Mortality risk / P-selectin / Parameters / Patients / Phospholipase A2 / platelet activation / platelets / Proteins / Respiratory failure / risk / SARS-CoV-2 / Serum levels / Severe acute respiratory syndrome coronavirus 2 / Vaccination / Vascular cell adhesion molecule 1 / vascular cell adhesion molecules / Viral diseases