Prognostic Markers in Hospitalized COVID-19 Patients: The Role of IP-10 and C-Reactive Protein
Manuela Rizzi, Martina Costanzo, Stelvio Tonello, Erica Matino, Giuseppe Francesco Casciaro, Alessandro Croce, Eleonora Rizzi, Erika Zecca, Anita Rebecca Pedrinelli, Veronica Vassia, Raffaella Landi, Mattia Bellan, Luigi Mario Castello, Rosalba Minisini, Venkata Ramana Mallela, Gian Carlo Avanzi, Mario Pirisi, Daniele Lilleri, Pier Paolo Sainaghi
Abstract
Background. SARS-CoV-2 is responsible for COVID-19, a clinically heterogeneous disease, ranging from being completely asymptomatic to life-threating manifestations. An unmet clinical need is the identification at disease onset or during its course of reliable biomarkers allowing patients’ stratification according to disease severity. In this observational prospective cohort study, patients’ immunologic and laboratory signatures were analyzed to identify independent predictors of unfavorable (either death or intensive care unit admission need) or favorable (discharge and/or clinical resolution within the first 14 days of hospitalization) outcome. Methods. Between January and May 2021 (third wave of the pandemic), we enrolled 139 consecutive SARS-CoV-2 positive patients hospitalized in Northern Italy to study their immunological and laboratory signatures. Multiplex cytokine, chemokine, and growth factor analysis, along with routine laboratory tests, were performed at baseline and after 7 days of hospital stay. Results. According to their baseline characteristics, the majority of our patients experienced a moderate to severe illness. At multivariate analysis, the only independent predictors of disease evolution were the serum concentrations of IP-10 (at baseline) and of C-reactive protein (CRP) after 7 days of hospitalization. Receiver-operating characteristic (ROC) curve analysis confirmed that baseline <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mtext>IP</a:mtext> <a:mo>−</a:mo> <a:mn>10</a:mn> <a:mo>></a:mo> <a:mn>4271</a:mn> <a:mtext> </a:mtext> <a:mtext>pg</a:mtext> <a:mo>/</a:mo> <a:mtext>mL</a:mtext> </a:math> and <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mtext>CRP</c:mtext> <c:mo>></c:mo> <c:mn>2.3</c:mn> <c:mtext> </c:mtext> <c:mtext>mg</c:mtext> <c:mo>/</c:mo> <c:mtext>dL</c:mtext> </c:math> at 7 days predict a worsening in clinical conditions (87% sensitivity, 66% specificity, area under the curve (AUC) 0.772, <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mi>p</e:mi> <e:mo><</e:mo> <e:mn>0.001</e:mn> </e:math> and 83% sensitivity, 73% specificity, AUC 0.826, <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mi>p</g:mi> <g:mo><</g:mo> <g:mn>0.001</g:mn> </g:math> , respectively). Conclusions. According to our results, baseline IP-10 and CRP after 7 days of hospitalization could be useful in driving clinical decisions tailored to the expected disease trajectory in hospitalized COVID-19 patients.