Abstract
Background: Inflammation has been implicated in the pathogenesis, severity, and outcomes of COVID-19. Extracellular newly identified receptor for advanced glycation end-product (EN-RAGE), a soluble EF-hand calcium-binding protein, causes integrin activation, activates inflammation, and upregulates the synthesis of vascular cell adhesion molecule-1 and intracellular adhesion molecule-1. While it is positively associated with atherosclerosis, high EN-RAGE levels have been shown to predict remission of auto-immune diseases. The role of EN-RAGE as a biomarker in COVID-19 is unknown. Methods: Serum EN-RAGE levels were measured from blood samples of 146 COVID-19 in-patients using Myriad® Cytokine MAP and compared between the subgroups based on race and outcomes. T-test, Chi-square, and multivariable regression analysis were performed to identify the correlation of EN-RAGE with race and outcomes. Results: Of 146 patients (mean age=59 years), 60% were female, 35% were White, and 60% were African Americans. 21 of the 146 (14%) patients died. Mortality was higher in Whites compared to African Americans (21% vs 10%) consistent with CDC data showing higher mortality in Whites compared to non-Whites. Surprisingly, African Americans had significantly higher EN-RAGE levels compared to Whites. (574.6 vs 360.9 respectively, p=0.002). Congruently, EN-RAGE levels were significantly higher in the patients who survived compared to the patients who died. (514.82 vs 336.29, p=0.039) suggesting that increased serum EN-RAGE levels may be associated with improved outcomes in hospitalized COVID-19 patients. Conclusion: Our study reveals a negative association of EN-RAGE levels with in-patient mortality associated with COVID-19 and could possibly be used as a biomarker of survival in hospitalized COVID-19 patients. EN-RAGE levels could partly explain mortality differences based on race. Further studies are required to confirm this association.
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