Same Virus, Different Course: The Relationship Between Monocyte Chemoattractant Protein-1 and Surfactant Protein-A Levels And Clinical Course and Prognosis of COVID-19

Abstract

Introduction: To date, over 165 million people have been infected in the COVID-19 pandemic caused by the novel coronavirus SARS-CoV-2 which emerged in Wuhan, China in December 2019. This study examined the relation between serum monocyte chemoattractant protein-1 and surfactant protein-A levels and the clinical course and prognosis of COVID-19. Materials and Methods: The study included a total of 108 subjects. Those in the patient group (n= 88) were diagnosed with COVID-19 using real-time PCR analysis of nasopharyngeal swab samples and treated in the Pulmonary Diseases Intensive Care Unit and the Infectious Diseases Department between March 24 and May 20. The control group (n= 20) included asymptomatic healthcare workers whose real-time PCR results during routine COVID-19 screening in our hospital were negative. Results: The COVID-19 patient group had significantly higher monocyte chemoattractant protein-1 and SP-A levels compared to the control group (p= 0.001, p= 0.001). Patients who developed macrophage activation syndrome had significantly higher monocyte chemoattractant protein-1 and surfactant protein-A levels than those who did not both at admission (p= 0.001, p= 0.001) and on day 5 of treatment (p= 0.05, p= 0.04). Similarly, monocyte chemoattractant protein-1 and surfactant protein-A levels were significantly higher in patients who developed acute respiratory distress syndrome compared to those who did not at both time points (p= 0.001 for all). Both parameters were significantly higher in non-surviving COVID-19 patients compared to survivors (p= 0.001 for both). Conclusion: Monocyte chemoattractant protein-1 and surfactant protein-A are on opposing sides of the inflammatory balance, and SP-A may be a pneumoprotein of importance in the presentation, course, prognosis, and possibly the treatment of COVID-19 in the future.