Abstract
BackgroundSurfactant protein D (SP-D) and pulmonary club cell protein 16 (CC-16) are called “pneumoproteins” and are involved in host defense against oxidative stress, inflammation, and viral outbreak. This study aimed to determine the predictive value of these pneumoproteins on the incidence of acute respiratory distress syndrome (ARDS) or death in patients with coronavirus disease-2019 (COVID-19).MethodsThis retrospective study included 87 patients admitted to an emergency department. Blood samples were collected on three time points (days 1, 5, and 14 from hospital admission). SP-D and CC-16 serum levels were determined, and univariate and multivariate analyses considering confounding variables (age, body mass index, tobacco use, dyspnea, hypertension, diabetes mellitus, neutrophil-to-lymphocyte ratio) were performed.ResultsBased on the multivariate analysis, SP-D level on D1 was positively and slightly correlated with subsequent development of ARDS, independent of body mass index, dyspnea, and diabetes mellitus. CC-16 level on D1 was modestly and positively correlated with fatal outcome. A rise in SP-D between D1 and D5 and D1 and D14 had a strong negative association with incidence of ARDS. These associations were independent of tobacco use and neutrophil-to-lymphocyte ratio.ConclusionsOverall, our data reveal that increase in SP-D levels is a good prognostic factor for patients with COVID-19, and that initial CC-16 levels correlated with slightly higher risk of death. SP-D and CC-16 may prove useful to predict outcomes in patients with COVID-19.
Highlights
A mature pulmonary epithelium is composed of several types of cells, such as specialized epithelial cells, goblet cells, basal cells, neuroendocrine cells, and club cells, to cite a few
Further multivariate analyses showed the independence of Surfactant protein D (SP-D) kinetic for the prediction of acute respiratory distress syndrome (ARDS) onset, considering neutrophil-to-lymphocyte ratio as another confounding variable; [3] a rise in SP-D/club cell 16 protein (CC-16) ratio from days 7 to 12 since symptom onset (D1 to D5 in the analysis) lessens the risk of ARDS by about one-fifth; [4] elevated levels of CC-16 on the day of admission are associated with a greater risk of fatal outcome
A previous study including several etiologies of ARDS has demonstrated that CC-16 at baseline was correlated with ARDS onset based on univariate analysis but lost its predictive value on multivariate analysis [48]. This is in line with our results, where we found that early rise of circulating levels of CC-16 is associated to a 4fold risk of developing ARDS in univariate analysis, but not in multivariate analysis
Summary
A mature pulmonary epithelium is composed of several types of cells, such as specialized epithelial cells, goblet cells, basal cells, neuroendocrine cells, and club cells ( named Clara cells), to cite a few. Club cells and non-ciliated bronchiolar cells synthetize the club cell 16 protein (CC-16), known as uteroglobin, which is a 15.8-kDa homomeric lung protein encoded by the secretoglobin family 1A member 1 (SCGB1A1) gene [2,3,4]. This protein is detectable in blood because of its transfer from the epithelial barrier to the blood stream, and it seems to be one of the most common proteins in the bronchoalveolar liquid [2, 4]. This study aimed to determine the predictive value of these pneumoproteins on the incidence of acute respiratory distress syndrome (ARDS) or death in patients with coronavirus disease-2019 (COVID-19)
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