Laboratory Biomarkers for Diagnosis and Prognosis in COVID-19

Overview

Journal Front Immunol

Specialty Allergy & Immunology

Date 2022 May 16

PMID 35572561

Authors

Denise Battaglini

Miqueias Lopes-Pacheco

Hugo C Castro-Faria-Neto

Paolo Pelosi

Patricia R M Rocco

Affiliations

Soon will be listed here.

Abstract

Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) causes a wide spectrum of clinical manifestations, with progression to multiorgan failure in the most severe cases. Several biomarkers can be altered in coronavirus disease 2019 (COVID-19), and they can be associated with diagnosis, prognosis, and outcomes. The most used biomarkers in COVID-19 include several proinflammatory cytokines, neuron-specific enolase (NSE), lactate dehydrogenase (LDH), aspartate transaminase (AST), neutrophil count, neutrophils-to-lymphocytes ratio, troponins, creatine kinase (MB), myoglobin, D-dimer, brain natriuretic peptide (BNP), and its N-terminal pro-hormone (NT-proBNP). Some of these biomarkers can be readily used to predict disease severity, hospitalization, intensive care unit (ICU) admission, and mortality, while others, such as metabolomic and proteomic analysis, have not yet translated to clinical practice. This narrative review aims to identify laboratory biomarkers that have shown significant diagnostic and prognostic value for risk stratification in COVID-19 and discuss the possible clinical application of novel analytic strategies, like metabolomics and proteomics. Future research should focus on identifying a limited but essential number of laboratory biomarkers to easily predict prognosis and outcome in severe COVID-19.

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References

Martinez Mesa A, Cabrera Cesar E, Martin-Montanez E, Sanchez Alvarez E, Martinez Lopez P, Romero-Zerbo Y . Acute Lung Injury Biomarkers in the Prediction of COVID-19 Severity: Total Thiol, Ferritin and Lactate Dehydrogenase. Antioxidants (Basel). 2021; 10(8). PMC: 8388961. DOI: 10.3390/antiox10081221. View

Poudel A, Poudel Y, Adhikari A, Aryal B, Dangol D, Bajracharya T . D-dimer as a biomarker for assessment of COVID-19 prognosis: D-dimer levels on admission and its role in predicting disease outcome in hospitalized patients with COVID-19. PLoS One. 2021; 16(8):e0256744. PMC: 8389366. DOI: 10.1371/journal.pone.0256744. View

Leisman D, Ronner L, Pinotti R, Taylor M, Sinha P, Calfee C . Cytokine elevation in severe and critical COVID-19: a rapid systematic review, meta-analysis, and comparison with other inflammatory syndromes. Lancet Respir Med. 2020; 8(12):1233-1244. PMC: 7567529. DOI: 10.1016/S2213-2600(20)30404-5. View

Sui J, Noubouossie D, Gandotra S, Cao L . Elevated Plasma Fibrinogen Is Associated With Excessive Inflammation and Disease Severity in COVID-19 Patients. Front Cell Infect Microbiol. 2021; 11:734005. PMC: 8369350. DOI: 10.3389/fcimb.2021.734005. View

de Guadiana-Romualdo L, Martinez Martinez M, Rodriguez Mulero M, Esteban-Torrella P, Hernandez Olivo M, Alcaraz Garcia M . Circulating MR-proADM levels, as an indicator of endothelial dysfunction, for early risk stratification of mid-term mortality in COVID-19 patients. Int J Infect Dis. 2021; 111:211-218. PMC: 8400460. DOI: 10.1016/j.ijid.2021.08.058. View

Chung M, Zidar D, Bristow M, Cameron S, Chan T, Harding 3rd C . COVID-19 and Cardiovascular Disease: From Bench to Bedside. Circ Res. 2021; 128(8):1214-1236. PMC: 8048382. DOI: 10.1161/CIRCRESAHA.121.317997. View

Ross Reichard R, Kashani K, Boire N, Constantopoulos E, Guo Y, Lucchinetti C . Neuropathology of COVID-19: a spectrum of vascular and acute disseminated encephalomyelitis (ADEM)-like pathology. Acta Neuropathol. 2020; 140(1):1-6. PMC: 7245994. DOI: 10.1007/s00401-020-02166-2. View

Battaglini D, Santori G, Chandraptham K, Iannuzzi F, Bastianello M, Tarantino F . Neurological Complications and Noninvasive Multimodal Neuromonitoring in Critically Ill Mechanically Ventilated COVID-19 Patients. Front Neurol. 2020; 11:602114. PMC: 7729072. DOI: 10.3389/fneur.2020.602114. View

Lasso G, Khan S, Allen S, Mariano M, Florez C, Orner E . Longitudinally monitored immune biomarkers predict the timing of COVID-19 outcomes. PLoS Comput Biol. 2022; 18(1):e1009778. PMC: 8812869. DOI: 10.1371/journal.pcbi.1009778. View

10.

Wang R, He M, Kang Y . A risk score based on procalcitonin for predicting acute kidney injury in COVID-19 patients. J Clin Lab Anal. 2021; 35(6):e23805. PMC: 8183912. DOI: 10.1002/jcla.23805. View

11.

Ambrosino P, Calcaterra I, Molino A, Moretta P, Lupoli R, Spedicato G . Persistent Endothelial Dysfunction in Post-Acute COVID-19 Syndrome: A Case-Control Study. Biomedicines. 2021; 9(8). PMC: 8391623. DOI: 10.3390/biomedicines9080957. View

12.

Tonelli R, Marchioni A, Tabbi L, Fantini R, Busani S, Castaniere I . Spontaneous Breathing and Evolving Phenotypes of Lung Damage in Patients with COVID-19: Review of Current Evidence and Forecast of a New Scenario. J Clin Med. 2021; 10(5). PMC: 7958611. DOI: 10.3390/jcm10050975. View

13.

Janneh A, Kassir M, Dwyer C, Chakraborty P, Pierce J, Flume P . Alterations of lipid metabolism provide serologic biomarkers for the detection of asymptomatic versus symptomatic COVID-19 patients. Sci Rep. 2021; 11(1):14232. PMC: 8270895. DOI: 10.1038/s41598-021-93857-7. View

14.

Faour W, Choaib A, Issa E, El Choueiry F, Shbaklo K, Alhajj M . Mechanisms of COVID-19-induced kidney injury and current pharmacotherapies. Inflamm Res. 2021; 71(1):39-56. PMC: 8606168. DOI: 10.1007/s00011-021-01520-8. View

15.

Tantry U, Bliden K, Cho A, Walia N, Dahlen J, Ens G . First Experience Addressing the Prognostic Utility of Novel Urinary Biomarkers in Patients With COVID-19. Open Forum Infect Dis. 2021; 8(7):ofab274. PMC: 8194603. DOI: 10.1093/ofid/ofab274. View

16.

Pelosi P, Ball L, S V Barbas C, Bellomo R, Burns K, Einav S . Personalized mechanical ventilation in acute respiratory distress syndrome. Crit Care. 2021; 25(1):250. PMC: 8284184. DOI: 10.1186/s13054-021-03686-3. View

17.

Metkus T, Sokoll L, Barth A, Czarny M, Hays A, Lowenstein C . Myocardial Injury in Severe COVID-19 Compared With Non-COVID-19 Acute Respiratory Distress Syndrome. Circulation. 2020; 143(6):553-565. PMC: 7864609. DOI: 10.1161/CIRCULATIONAHA.120.050543. View

18.

Sorrentino S, Cacia M, Leo I, Polimeni A, Sabatino J, Spaccarotella C . B-Type Natriuretic Peptide as Biomarker of COVID-19 Disease Severity-A Meta-Analysis. J Clin Med. 2020; 9(9). PMC: 7564464. DOI: 10.3390/jcm9092957. View

19.

Zhang C, Wu Z, Li J, Zhao H, Wang G . Cytokine release syndrome in severe COVID-19: interleukin-6 receptor antagonist tocilizumab may be the key to reduce mortality. Int J Antimicrob Agents. 2020; 55(5):105954. PMC: 7118634. DOI: 10.1016/j.ijantimicag.2020.105954. View

20.

Yassin A, Ghzawi A, Al-Mistarehi A, El-Salem K, Benmelouka A, M Sherif A . Mortality rate and biomarker expression within COVID-19 patients who develop acute ischemic stroke: a systematic review and meta-analysis. Future Sci OA. 2021; 7(7):FSO713. PMC: 8114837. DOI: 10.2144/fsoa-2021-0036. View