Abstract
Although several biomarkers have shown correlation to prognosis in COVID-19 patients, their clinical value is limited because of lack of specificity, suboptimal sensibility or poor dynamic behavior. We hypothesized that circulating soluble ST2 (sST2) could be associated to a worse outcome in COVID-19. In total, 152 patients admitted for confirmed COVID-19 were included in a prospective non-interventional, observational study. Blood samples were drawn at admission, 48–72 h later and at discharge. sST2 concentrations and routine blood laboratory were analyzed. Primary endpoints were admission at intensive care unit (ICU) and mortality. Median age was 57.5 years [Standard Deviation (SD: 12.8)], 60.4% males. 10% of patients (n = 15) were derived to ICU and/or died during admission. Median (IQR) sST2 serum concentration (ng/mL) rose to 53.1 (30.9) at admission, peaked at 48–72 h (79.5(64)) and returned to admission levels at discharge (44.9[36.7]). A concentration of sST2 above 58.9 ng/mL was identified patients progressing to ICU admission or death. Results remained significant after multivariable analysis. The area under the receiver operating characteristics curve (AUC) of sST2 for endpoints was 0.776 (p = 0.001). In patients admitted for COVID-19 infection, early measurement of sST2 was able to identify patients at risk of severe complications or death.
Highlights
Study Design and SettingA prospective cohort study was carried out at the Infectious diseases and Internal Medicine departments of a tertiary teaching center (Hospital Clínico Universitario “Lozano Blesa”, Zaragoza, Spain), between July and November 2020
Introduction iationsCoronavirus disease 2019 (COVID-19) is a worldwide pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), an infectious disease leading to high morbidity and mortality [1,2,3].Clinical spectrum of COVID-19 ranges from asymptomatic patients to severe pneumoniae, with multi-organ symptoms and/or failure, including cardiological, neurological or thrombotic manifestations [4]
We present our results demonstrating that early changes in blood soluble ST2 (sST2) have an excellent prognostic value in COVID-19, surpassing more traditional markers having been used during the pandemic
Summary
A prospective cohort study was carried out at the Infectious diseases and Internal Medicine departments of a tertiary teaching center (Hospital Clínico Universitario “Lozano Blesa”, Zaragoza, Spain), between July and November 2020. (COVID-19) infection by nasopharyngeal polymerase chain reaction (PCR) or specific serology (IgM and/or IgG) in the context of clinical respiratory infection. (1) Primary admission at Intensive Care Unit. (3) Functional dependence (Barthel index < 50 points). (5) Advanced chronic obstructive pulmonary disease (COPD) (FEV1 < 30%) or a history of emphysema and/or pulmonary fibrosis. The study complied with the fundamental guidelines of the Helsinki declaration guidelines and was evaluated and approved by Aragón’s Committee on Research Ethics (CEICA, Ref. PI20/248, 13 May 2020)
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