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Hurler L, Mescia F, Bergamaschi L, Kajdácsi E, Sinkovits G, Cervenak L, Prohászka Z, Lyons PA, Toonen EJ. sMR and PTX3 levels associate with COVID-19 outcome and survival but not with Long COVID. iScience 2024; 27:110162. [PMID: 39027374 PMCID: PMC11255846 DOI: 10.1016/j.isci.2024.110162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/28/2024] [Accepted: 05/29/2024] [Indexed: 07/20/2024] Open
Abstract
Biomarkers for monitoring COVID-19 disease course are lacking. Study aim was to identify biomarkers associated with disease severity, survival, long-term outcome, and Long COVID. As excessive macrophages activation is a hallmark of COVID-19 and complement activation is key in this, we selected the following proteins involved in these processes: PTX3, C1q, C1-INH, C1s/C1-INH, and sMR. EDTA-plasma concentrations were measured in 215 patients and 47 controls using ELISA. PTX3, sMR, C1-INH, and C1s/C1-INH levels were associated with disease severity. PTX3 and sMR were also associated with survival and long-term immune recovery. Lastly, sMR levels associate with ICU admittance. sMR (AUC 0.85) and PTX3 (AUC 0.78) are good markers for disease severity, especially when used in combination (AUC 0.88). No association between biomarker levels and Long COVID was observed. sMR has not previously been associated with COVID-19 disease severity, ICU admittance or survival and may serve as marker for disease course.
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Affiliation(s)
- Lisa Hurler
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Federica Mescia
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, Jeffrey Cheah Biomedical Centre, University of Cambridge, Cambridge CB2 0AW, UK
- Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
| | - Laura Bergamaschi
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, Jeffrey Cheah Biomedical Centre, University of Cambridge, Cambridge CB2 0AW, UK
- Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
| | - Cambridge Institute of Therapeutic Immunology and Infectious Disease-National Institute of Health Research (CITIID-NIHR) COVID BioResource Collaboration
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, Jeffrey Cheah Biomedical Centre, University of Cambridge, Cambridge CB2 0AW, UK
- Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
- Research Group for Immunology and Haematology, Semmelweis University - Eötvös Loránd Research Network (Office for Supported Research Groups), Budapest, Hungary
- Research and Development Department, Hycult Biotech, Uden, the Netherlands
| | - Erika Kajdácsi
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - György Sinkovits
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - László Cervenak
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Zoltán Prohászka
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
- Research Group for Immunology and Haematology, Semmelweis University - Eötvös Loránd Research Network (Office for Supported Research Groups), Budapest, Hungary
| | - Paul A. Lyons
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, Jeffrey Cheah Biomedical Centre, University of Cambridge, Cambridge CB2 0AW, UK
- Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
| | - Erik J.M. Toonen
- Research and Development Department, Hycult Biotech, Uden, the Netherlands
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Scavello F, Brunetta E, Mapelli SN, Nappi E, García Martín ID, Sironi M, Leone R, Solano S, Angelotti G, Supino D, Carnevale S, Zhong H, Magrini E, Stravalaci M, Protti A, Santini A, Costantini E, Savevski V, Voza A, Bottazzi B, Bartoletti M, Cecconi M, Mantovani A, Morelli P, Tordato F, Garlanda C. The long Pentraxin PTX3 serves as an early predictive biomarker of co-infections in COVID-19. EBioMedicine 2024; 105:105213. [PMID: 38908098 PMCID: PMC11245991 DOI: 10.1016/j.ebiom.2024.105213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/27/2024] [Accepted: 06/07/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND COVID-19 clinical course is highly variable and secondary infections contribute to COVID-19 complexity. Early detection of secondary infections is clinically relevant for patient outcome. Procalcitonin (PCT) and C-reactive protein (CRP) are the most used biomarkers of infections. Pentraxin 3 (PTX3) is an acute phase protein with promising performance as early biomarker in infections. In patients with COVID-19, PTX3 plasma concentrations at hospital admission are independent predictor of poor outcome. In this study, we assessed whether PTX3 contributes to early identification of co-infections during the course of COVID-19. METHODS We analyzed PTX3 levels in patients affected by COVID-19 with (n = 101) or without (n = 179) community or hospital-acquired fungal or bacterial secondary infections (CAIs or HAIs). FINDINGS PTX3 plasma concentrations at diagnosis of CAI or HAI were significantly higher than those in patients without secondary infections. Compared to PCT and CRP, the increase of PTX3 plasma levels was associated with the highest hazard ratio for CAIs and HAIs (aHR 11.68 and 24.90). In multivariable Cox regression analysis, PTX3 was also the most significant predictor of 28-days mortality or intensive care unit admission of patients with potential co-infections, faring more pronounced than CRP and PCT. INTERPRETATION PTX3 is a promising predictive biomarker for early identification and risk stratification of patients with COVID-19 and co-infections. FUNDING Dolce & Gabbana fashion house donation; Ministero della Salute for COVID-19; EU funding within the MUR PNRR Extended Partnership initiative on Emerging Infectious Diseases (Project no. PE00000007, INF-ACT) and MUR PNRR Italian network of excellence for advanced diagnosis (Project no. PNC-E3-2022-23683266 PNC-HLS-DA); EU MSCA (project CORVOS 860044).
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Affiliation(s)
| | - Enrico Brunetta
- Infectious Diseases Unit, Hospital Health Direction, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Sarah N Mapelli
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Emanuele Nappi
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy
| | - Ian David García Martín
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy
| | - Marina Sironi
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Roberto Leone
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Simone Solano
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Giovanni Angelotti
- Artificial Intelligence Center, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Domenico Supino
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | | | - Hang Zhong
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy
| | - Elena Magrini
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | | | - Alessandro Protti
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Alessandro Santini
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Elena Costantini
- Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Victor Savevski
- Artificial Intelligence Center, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Antonio Voza
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy; Emergency Department, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | | | - Michele Bartoletti
- Infectious Diseases Unit, Hospital Health Direction, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Alberto Mantovani
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy; The William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Paola Morelli
- Infectious Diseases Unit, Hospital Health Direction, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Federica Tordato
- Infectious Diseases Unit, Hospital Health Direction, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Cecilia Garlanda
- IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy.
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Kanaeva TV, Karoli NA. Prognostic biomarkers for cardiovascular injury in patients with COVID-19: a review. SECHENOV MEDICAL JOURNAL 2023. [DOI: 10.47093/2218-7332.2022.13.3.14-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Investigations into the causes of adverse outcomes of the novel coronavirus infection (COVID-19) have been ongoing since the beginning of the pandemic. There is evidence that coronavirus-induced cardiovascular injury is as important to a risk of adverse outcome as respiratory injury. Many studies have shown that concomitant cardiovascular disease aggravates the course of COVID-19. However, in some patients who did not have cardiovascular diseases before COVID-19, they are detected during hospitalization or after discharge from the hospital. The review examines data on the effect of serum biomarkers of cardiovascular disease determined during COVID-19 on the risk of adverse outcomes in the near and long-term follow-up periods. Among such biomarkers are considered: troponins, N-terminal pro B-type natriuretic peptide, creatine phosphokinase-MB, lactate dehydrogenase, myoglobin, growth stimulation expressed gene 2, pentraxin 3, angiotensin II, as well as D-dimer and homocysteine. Threshold values have been set for some of these biomarkers, which allow predicting the risk of an unfavorable outcome. At the same time, in most prognostic models, these markers are considered in association with cytokine storm indicators and other risk factors.
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Affiliation(s)
- T. V. Kanaeva
- Saratov State Medical University named after V.I. Razumovsky
| | - N. A. Karoli
- Saratov State Medical University named after V.I. Razumovsky
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Lapadula G, Leone R, Bernasconi DP, Biondi A, Rossi E, D’Angiò M, Bottazzi B, Bettini LR, Beretta I, Garlanda C, Valsecchi MG, Mantovani A, Bonfanti P. Long pentraxin 3 (PTX3) levels predict death, intubation and thrombotic events among hospitalized patients with COVID-19. Front Immunol 2022; 13:933960. [PMID: 36389697 PMCID: PMC9651085 DOI: 10.3389/fimmu.2022.933960] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 10/17/2022] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND PTX3 is an important mediator of inflammation and innate immunity. We aimed at assessing its prognostic value in a large cohort of patients hospitalized with COVID-19. METHODS Levels of PTX3 were measured in 152 patients hospitalized with COVID-19 at San Gerardo Hospital (Monza, Italy) since March 2020. Cox regression was used to identify predictors of time from admission to in-hospital death or mechanical ventilation. Crude incidences of death were compared between patients with PTX3 levels higher or lower than the best cut-off estimated with the Maximally Selected Rank Statistics Method. RESULTS Upon admission, 22% of the patients required no oxygen, 46% low-flow oxygen, 30% high-flow nasal cannula or CPAP-helmet and 3% MV. Median level of PTX3 was 21.7 (IQR: 13.5-58.23) ng/ml. In-hospital mortality was 25% (38 deaths); 13 patients (8.6%) underwent MV. PTX3 was associated with risk of death (per 10 ng/ml, HR 1.08; 95%CI 1.04-1.11; P<0.001) and death/MV (HR 1.04; 95%CI 1.01-1.07; P=0.011), independently of other predictors of in-hospital mortality, including age, Charlson Comorbidity Index, D-dimer and C-reactive protein (CRP). Patients with PTX3 levels above the optimal cut-off of 39.32 ng/ml had significantly higher mortality than the others (55% vs 8%, P<0.001). Higher PTX3 plasma levels were found in 14 patients with subsequent thrombotic complications (median [IQR]: 51.4 [24.6-94.4] versus 21 [13.4-55.2]; P=0.049). CONCLUSIONS High PTX3 levels in patients hospitalized with COVID-19 are associated with a worse outcome. The evaluation of this marker could be useful in prognostic stratification and identification of patients who could benefit from immunomodulant therapy.
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Affiliation(s)
- Giuseppe Lapadula
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Infectious Diseases, San Gerardo Hospital, Monza, Italy
| | | | - Davide Paolo Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Center - B4, University of Milano–Bicocca, Milan, Italy
| | - Andrea Biondi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Pediatrics, European Reference Network (ERN) PaedCan, EuroBloodNet, MetabERN Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM)/Ospedale San Gerardo, Monza, Italy
| | - Emanuela Rossi
- Bicocca Bioinformatics Biostatistics and Bioimaging Center - B4, University of Milano–Bicocca, Milan, Italy
| | - Mariella D’Angiò
- Department of Pediatrics, European Reference Network (ERN) PaedCan, EuroBloodNet, MetabERN Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM)/Ospedale San Gerardo, Monza, Italy
| | | | - Laura Rachele Bettini
- Department of Pediatrics, European Reference Network (ERN) PaedCan, EuroBloodNet, MetabERN Fondazione Monza e Brianza per il Bambino e la sua Mamma (MBBM)/Ospedale San Gerardo, Monza, Italy
| | - Ilaria Beretta
- Department of Infectious Diseases, San Gerardo Hospital, Monza, Italy
| | - Cecilia Garlanda
- IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Maria Grazia Valsecchi
- Bicocca Bioinformatics Biostatistics and Bioimaging Center - B4, University of Milano–Bicocca, Milan, Italy
| | - Alberto Mantovani
- IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- William Harvey Research Institute, Queen Mary University, London, United Kingdom
| | - Paolo Bonfanti
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Infectious Diseases, San Gerardo Hospital, Monza, Italy
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Worku DA. SARS-CoV-2 Associated Immune Dysregulation and COVID-Associated Pulmonary Aspergilliosis (CAPA): A Cautionary Tale. Int J Mol Sci 2022; 23:3228. [PMID: 35328649 PMCID: PMC8953852 DOI: 10.3390/ijms23063228] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 02/01/2023] Open
Abstract
As the global SARS-CoV-2 pandemic continues to plague healthcare systems, it has become clear that opportunistic pathogens cause a considerable proportion of SARS-CoV-2-associated mortality and morbidity cases. Of these, Covid-Associated Pulmonary Aspergilliosis (CAPA) is a major concern with evidence that it occurs in the absence of traditional risk factors such as neutropenia and is diagnostically challenging for the attending physician. In this review, we focus on the immunopathology of SARS-CoV-2 and how this potentiates CAPA through dysregulation of local and systemic immunity as well as the unintended consequences of approved COVID treatments including corticosteroids and IL-6 inhibitors. Finally, we will consider how knowledge of the above may aid in the diagnosis of CAPA using current diagnostics and what treatment should be instituted in probable and confirmed cases.
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Affiliation(s)
- Dominic Adam Worku
- Infectious Diseases and Microbiology Department, Morriston Hospital, Swansea University Health Board, Swansea SA6 6NL, UK;
- Public Health Wales, Cardiff CF10 4BZ, UK
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Biomarkers Associated with Cardiovascular Disease in COVID-19. Cells 2022; 11:cells11060922. [PMID: 35326373 PMCID: PMC8946710 DOI: 10.3390/cells11060922] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/20/2022] [Accepted: 03/05/2022] [Indexed: 02/08/2023] Open
Abstract
Coronavirus disease-19 (COVID-19) emerged late December 2019 in the city of Wuhan, China and has since spread rapidly all over the world causing a global pandemic. While the respiratory system is the primary target of disease manifestation, COVID-19 has been shown to also affect several other organs, making it a rather complex, multi-system disease. As such, cardiovascular involvement has been a topic of discussion since the beginning of the COVID-19 pandemic, primarily due to early reports of excessive myocardial injury in these patients. Treating physicians are faced with multiple challenges in the management and early triage of patients with COVID-19, as disease severity is highly variable ranging from an asymptomatic infection to critical cases rapidly deteriorating to intensive care treatment or even fatality. Laboratory biomarkers provide important prognostic information which can guide decision making in the emergency department, especially in patients with atypical presentations. Several cardiac biomarkers, most notably high-sensitive cardiac troponin (hs-cTn) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), have emerged as valuable predictors of prognosis in patients with COVID-19. The purpose of this review was to offer a concise summary on prognostic cardiac biomarkers in COVID-19 and discuss whether routine measurements of these biomarkers are warranted upon hospital admission.
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Ferrari M, Protti A. Nitric oxide in COVID-19: Too little of a good thing? EBioMedicine 2022; 77:103925. [PMID: 35278744 PMCID: PMC8906241 DOI: 10.1016/j.ebiom.2022.103925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Michele Ferrari
- Anaesthesia and Intensive Care Units, Humanitas Clinical and Research Hospital, IRCCS, Rozzano, Milan, Italy
| | - Alessandro Protti
- Anaesthesia and Intensive Care Units, Humanitas Clinical and Research Hospital, IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
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Atay T, Sahin K, Elevli M, Ustyol A, Oguz D, Ataoglu E, Duru HN. A Comparative Study of the Effectiveness of Serum C-reactive Protein and Serum Pentraxin-3 Levels in the Diagnosis and Follow-up of Neonatal Sepsis. HASEKI TIP BÜLTENI 2022. [DOI: 10.4274/haseki.galenos.2021.7308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Lynch SM, Guo G, Gibson DS, Bjourson AJ, Rai TS. Role of Senescence and Aging in SARS-CoV-2 Infection and COVID-19 Disease. Cells 2021; 10:3367. [PMID: 34943875 PMCID: PMC8699414 DOI: 10.3390/cells10123367] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/17/2021] [Accepted: 11/23/2021] [Indexed: 02/07/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in a global pandemic associated with substantial morbidity and mortality worldwide, with particular risk for severe disease and mortality in the elderly population. SARS-CoV-2 infection is driven by a pathological hyperinflammatory response which results in a dysregulated immune response. Current advancements in aging research indicates that aging pathways have fundamental roles in dictating healthspan in addition to lifespan. Our review discusses the aging immune system and highlights that senescence and aging together, play a central role in COVID-19 pathogenesis. In our review, we primarily focus on the immune system response to SARS-CoV-2 infection, the interconnection between severe COVID-19, immunosenescence, aging, vaccination, and the emerging problem of Long-COVID. We hope to highlight the importance of identifying specific senescent endotypes (or "sendotypes"), which can used as determinants of COVID-19 severity and mortality. Indeed, identified sendotypes could be therapeutically exploited for therapeutic intervention. We highlight that senolytics, which eliminate senescent cells, can target aging-associated pathways and therefore are proving attractive as potential therapeutic options to alleviate symptoms, prevent severe infection, and reduce mortality burden in COVID-19 and thus ultimately enhance healthspan.
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Affiliation(s)
| | | | | | | | - Taranjit Singh Rai
- Northern Ireland Centre for Stratified Medicine, School of Biomedical Sciences, Ulster University, C-TRIC Building, Altnagelvin Area Hospital, Glenshane Road, Derry BT47 6SB, UK; (S.M.L.); (G.G.); (D.S.G.); (A.J.B.)
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