بروتين أميلويد أ في مصل الدم كمؤشر لشدة مرض كوفيد-19 مقارنة مع بروتينات الطور الحاد الأخرى

Serum amyloid A protein as marker of severity of COVID-19 infection in comparison with other acute phase reactant mediators

Abstract

Global health resources have faced huge challenges from the pandemic of coronavirus disease (COVID-19) since December 2019. As on March 1, 2021, the world health organization reported that there were 113,467,303 confirmed cases worldwide with 2,520,550 confirmed deaths. Therefore, it is important to know the best biomarkers which might be associated with disease severity in order to avoid more death cases. The biomarkers that studied in COVID-19 were varied and they had significant role in the diagnosis, treatment, and prediction of the clinical outcomes of patients. Recently, it has been reported that Acute phase reactants have important role for the early diagnosis, treatment, and for monitoring the progression of COVID-19. Currently, there are few reports about the relationship between serum amyloid A and COVID-19 severity. Serum amyloid A is a plasma component and the precursor of amyloid. It is an acute phase protein mainly produced by the liver in response to proinflammatory cytokines that are secreted by the activated monocytes. Therefore, this study aimed to examine the feasibility of employed serum amyloid A protein levels towards COVID-19 severity since it had an ability to promote inflammatory response through activating chemokine and inducing chemotaxis even at a very low concentration.
Material and method: The study was a cross sectional study. It started in 3rd of October 2020 and finished in 15th of September 2021. The medical data of (91) COVID-19 patients admitted to Al-Hayat unit at Imam Hussein Medical City/ Kerbala were collected. COVID-19 cases were divided into three groups based on disease severity (moderate, severe, and critical). The levels of biomarkers were measured for the following parameter: Serum amyloid A was performed using ELISA Technique; Quantitative measurement of C-Reactive protein was determined through photometric measurement of immunocomplex; D-Dimer in plasma and serum ferritin were performed by sandwich chemiluminescence immunoassay; Complete blood count was done by XP-300™ Automated hematology analyzer Sysmex. The association between biochemical markers and disease severity was evaluated. The efficiency of the predicting value was assessed using receiver operating characteristic curve.
Results: Levels of hematological parameters (Red cell distribution width-coefficient of variation, White blood cells count, Neutrophils percentage, Lymphocytes percentage, and Neutrophils to lymphocytes ratio) were varied based on the severity of the disease. In critical COVID-19 patients, C-reactive protein has shown a significant correlation with neutrophils percentage, lymphocytes percentage, and neutrophils to lymphocytes ratio. Serum ferritin level was significantly higher in critical cases. In severe COVID-19 patients, serum amyloid A level had shown a significant negative correlation with red cell distribution width-coefficient of variation, neutrophils percentage, and neutrophils to lymphocytes ratio, while it had shown a positive correlation with lymphocytes percentage. Ratio of predictive value for the inflammatory indicators (serum amyloid A to C-reactive protein ratio) had shown statistically difference between the patient groups. Serum amyloid A to C-reactive protein ratio was significantly higher in severe and critical groups than those of moderate patients. Receiver operating characteristics curves indicated that the diagnostic performance of serum amyloid A to C-reactive protein ratio in both COVID-19 groups exhibited much better predictive value than other tests.
Conclusion: Levels of both C-reactive protein and serum amyloid A were statistically significant among groups of COVID-19 patients. The combination of these levels were assessed. In both groups COVID-19 patients (severe and critical), serum amyloid A to C-reactive protein ratio demonstrated a high prognosis value of the combined inflammatory indicators.