Abstract
Intestinal epithelial cell damage caused by SARS-CoV-2 infection was thought to be associated with gastrointestinal symptoms and decreased fecal consistency. The association of the gastrointestinal symptoms with the COVID-19-mediated inflammatory response triggered by the gastrointestinal immune system was investigated in this paper. Intestinal inflammation marker fecal calprotectin along with serum calprotectin and other inflammatory markers were measured in COVID-19 cases with and without GI manifestations as well as healthy individuals. Analyses were performed to compare COVID-19 patient subgroups and healthy controls and examine the relationship between fecal and serum calprotectin levels with gastrointestinal symptoms and disease severity. COVID-19 patients (n = 70) were found to have markedly elevated median levels of fecal (124.3 vs. 25.0 µg/g; P < 0/0001) and serum calprotectin (3500 vs. 1060 ng/mL; P < 0/0001) compared with uninfected controls. Fecal and serum calprotectin levels were not significantly different between COVID-19 patients who displayed GI symptoms and those who did not. Compared with other acute phase markers, both fecal and serum calprotectin were superior in identifying COVID-19 patients who progressed to severe illness. Although the progression of COVID-19 disease is marked by an elevation of fecal and serum calprotectin, gastrointestinal symptoms or diarrhea were not correlated with calprotectin increase level.
Highlights
Intestinal epithelial cell damage caused by SARS-CoV-2 infection was thought to be associated with gastrointestinal symptoms and decreased fecal consistency
Patients in the COVID-19 group had an average age of 51.47 ± 17.28 years, and cases in the healthy group had an average age of 47.74 ± 21.27 (P = 0.549)
We found that the biggest area under the Receiver Operating Curve (ROC) curve (AUC) belonged to serum calprotectin (SC) (0.842, 95% CI 0.753–0.932, P = 0.000) and fecal calprotectin (FC) (0.823, 95% CI 0.709–0.936, P = 0.000) as compared with the other markers which had slightly lower AUCs; C-reactive protein (CRP) (0.803, 95% CI 0.613–0.994, P = 0.001) (NLR and erythrocyte sedimentation rate (ESR) with lower AUCs were not shown) (Fig. 5F)
Summary
Intestinal epithelial cell damage caused by SARS-CoV-2 infection was thought to be associated with gastrointestinal symptoms and decreased fecal consistency. Analyses were performed to compare COVID19 patient subgroups and healthy controls and examine the relationship between fecal and serum calprotectin levels with gastrointestinal symptoms and disease severity. COVID-19 patients (n = 70) were found to have markedly elevated median levels of fecal (124.3 vs 25.0 μg/g; P < 0/0001) and serum calprotectin (3500 vs 1060 ng/mL; P < 0/0001) compared with uninfected controls. Compared with other acute phase markers, both fecal and serum calprotectin were superior in identifying COVID-19 patients who progressed to severe illness. The progression of COVID-19 disease is marked by an elevation of fecal and serum calprotectin, gastrointestinal symptoms or diarrhea were not correlated with calprotectin increase level. Demographics characterizations Gender, male Age (years) Age ≥ 65 years BMI Underlying diseases Hypertension Diabetes mellitus Cardiovascular disease Dyslipidemia Chronic kidney disease Chronic liver disease prior GI problems
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