Background: Recently, dyslipidaemia was observed in patients with coronavirus disease 2019 (COVID-19), especially in severe cases. This study aimed to explore the predictive value of blood lipid levels for COVID-19 severity. Methods: All patients with COVID-19 admitted to HwaMei Hospital, University of Chinese Academy of Sciences, from January 23 to April 20, 2020, were included in this retrospective study. General clinical characteristics and laboratory data (including blood lipid parameters) were obtained, and their predictive values for the severity were analysed. Results: In total, 142 consecutive patients with COVID-19 were included. The non-severe group included 125 cases, and 17 cases were included in the severe group. Total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and apolipoprotein A1 (ApoA1) at baseline were signi cantly lower in the severe group. ApoA1 and interleukin-6 (IL-6) were recognized as independent risk factors for COVID-19 severity. ApoA1 had the highest area under the receiver operator characteristic curve (AUC) among all the single markers (AUC: 0.896, 95% CI: 0.834-0.941). Moreover, the risk model established using ApoA1 and IL-6 enhanced the predictive value (AUC: 0.977, 95% CI: 0.932-0.995). On the other hand, ApoA1 levels were elevated in the severe group during treatment, and there was no signi cant difference between the severe and non-severe groups during the recovery stage of the disease. Conclusion: The blood lipid pro le in severe COVID-19 patients is quite different from that in non-severe cases. Serum ApoA1 could severe as a good indictor to re ect the severity of COVID-19.

The beginning of the twenty-rst century has been marked by three distinct waves of zoonotic coronavirus outbreaks into the human population. The current pandemic COVID-19 (Coronavirus disease 2019) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). With a rapid infection rate, it is a global threat endangering the livelihoods of millions worldwide. Currently, and despite the collaborative efforts of governments, researchers, and the pharmaceutical industries, there are no substantially signi cant treatment protocols for the disease. To address the need for such an immediate call of action, we leveraged the largest dataset of drug-induced transcriptomic perturbations, public SARS-CoV-2 transcriptomic datasets, and expression pro les from normal lung transcriptomes. Our unbiased systems biology approach not only shed light on previously unexplored molecular details of SARS-CoV-2 infection (e.g., interferon signaling, in ammation and ACE2 co-expression hallmarks in normal and infected lungs) but most importantly prioritized more than 50 repurposable drug candidates (e.g., Corticosteroids, Janus kinase and Bruton kinase inhibitors). Further clinical investigation of these FDA approved candidates as monotherapy or in combination with an antiviral regimen (e.g., Remdesivir) could lead to promising outcomes in COVID-19 patients.

AbstractObjectivesIn December 2019, there was an outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, and since then, the disease has been increasingly spread throughout the world. Unfortunately, the information about early prediction factors for disease progression is relatively limited. Therefore, there is an urgent need to investigate the risk factors of developing severe disease. The objective of the study was to reveal the risk factors of developing severe disease by comparing the differences in the hemocyte count and dynamic profiles in patients with severe and non-severe COVID-19.MethodsIn this retrospectively analyzed cohort, 141 confirmed COVID-19 patients were enrolled in Taizhou Public Health Medical Center, Taizhou Hospital, Zhejiang Province, China, from January 17, 2020 to February 26, 2020. Clinical characteristics and hemocyte counts of severe and non-severe COVID patients were collected. The differences in the hemocyte counts and dynamic profiles in patients with severe and non-severe COVID-19 were compared. Multivariate Cox regression analysis was performed to identify potential biomarkers for predicting disease progression. A concordance index (C-index), calibration curve, decision curve and the clinical impact curve were calculated to assess the predictive accuracy.ResultsThe data showed that the white blood cell count, neutrophil count and platelet count were normal on the day of hospital admission in most COVID-19 patients (87.9%, 85.1% and 88.7%, respectively). A total of 82.8% of severe patients had lymphopenia after the onset of symptoms, and as the disease progressed, there was marked lymphopenia. Multivariate Cox analysis showed that the neutrophil count (hazard ratio [HR] = 4.441, 95% CI = 1.954–10.090, p = 0.000), lymphocyte count (HR = 0.255, 95% CI = 0.097–0.669, p = 0.006) and platelet count (HR = 0.244, 95% CI = 0.111–0.537, p = 0.000) were independent risk factors for disease progression. The C-index (0.821 [95% CI, 0.746–0.896]), calibration curve, decision curve and the clinical impact curve showed that the nomogram can be used to predict the disease progression in COVID-19 patients accurately. In addition, the data involving the neutrophil count, lymphocyte count and platelet count (NLP score) have something to do with improving risk stratification and management of COVID-19 patients.ConclusionsWe designed a clinically predictive tool which is easy to use for assessing the progression risk of COVID-19, and the NLP score could be used to facilitate patient stratification management.

The utility of the urinary proteome in infectious diseases remains unclear. Here we analyzed the proteome and metabolome of urine and serum samples from patients with COVID-19 and healthy controls. Our data show that urinary proteins effectively classify COVID-19 by severity. We detect 197 cytokines and their receptors in urine but only 124 in serum using TMT-based proteomics. Decrease of urinary ESCRT complex proteins correlates with active SARS-CoV-2 replication. Downregulation of urinary CXCL14 in severe COVID-19 cases positively correlates with blood lymphocyte counts. Integrative multiomic analysis suggests that innate immune activation and inflammation triggered renal injuries in patients with COVID-19. COVID-19-associated modulation of the urinary proteome offers unique insights into the pathogenesis of this disease. This study demonstrates the added value of including the urinary proteome in a suite of multiomic analytes in evaluating the immune pathobiology and clinical course of COVID-19 and, potentially, other infectious diseases.

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24Severe COVID-19 patients account for most of the mortality of this disease. 25 Early detection and effective treatment of severe patients remain major 26 challenges. Here, we performed proteomic and metabolomic profiling of sera 27 from 46 COVID-19 and 53 control individuals. We then trained a machine 28 learning model using proteomic and metabolomic measurements from a 29 training cohort of 18 non-severe and 13 severe patients. The model correctly 30 classified severe patients with an accuracy of 93.5%, and was further 31 validated using ten independent patients, seven of which were correctly 32 classified. We identified molecular changes in the sera of COVID-19 patients 33 implicating dysregulation of macrophage, platelet degranulation and 34 complement system pathways, and massive metabolic suppression. This 35 study shows that it is possible to predict progression to severe COVID-19 36 disease using serum protein and metabolite biomarkers. Our data also 37 uncovered molecular pathophysiology of COVID-19 with potential for 38 developing anti-viral therapies.

RT-PCR is the primary method to diagnose COVID-19 and is also used to monitor the disease course. This approach, however, suffers from false negatives due to RNA instability and poses a high risk to medical practitioners. Here, we investigated the potential of using serum proteomics to predict viral nucleic acid positivity during COVID-19. We analyzed the proteome of 275 inactivated serum samples from 54 out of 144 COVID-19 patients and shortlisted 42 regulated proteins in the severe group and 12 in the non-severe group. Using these regulated proteins and several key clinical indexes, including days after symptoms onset, platelet counts, and magnesium, we developed two machine learning models to predict nucleic acid positivity, with an AUC of 0.94 in severe cases and 0.89 in non-severe cases, respectively. Our data suggest the potential of using a serum protein-based machine learning model to monitor COVID-19 progression, thus complementing swab RT-PCR tests. More efforts are required to promote this approach into clinical practice since mass spectrometry-based protein measurement is not currently widely accessible in clinic.

Background: Serum Amyloid A (SAA) is an acute-phase reactant downstream of the pro-inflammatory cytokines released during virus infection. However, the role of this inflammatory marker in SARA-CoV-2 infection is yet to be elucidated. Here, we explored the potential use of SAA in serum as a biomarker for monitoring the clinical course of COVID-19 patients.Methods: The subjects included 95 COVID-19 patients discharged from the hospital with acute and / or convalescent phases data, among them 69 patients had paired data. Mann-Whitney U statistics and Wilcoxon signed-rank test were used to compare SAA level in the acute and convalescent phases. A subgroup of COVID-19 patients (n=9) participated in a follow-up examination with repeated blood collection reach five times during the hospitalization. The correlations of SAA levels with laboratory testing were then analyzed using the Spearman test.Results: The results of the data analysis show that the media SAA levels at acute phases were significantly higher (P < 0.05) compared to that at baseline. Furthermore, ascensional range of SAA were associated with the degree of COVID-19 severity. Media SAA levels at convalescent phases were significantly decreased (P < 0.05) compared to that at acute phases. The same phenomenon was seen in patients with and without comorbidities and with fever patients except without fever patients. Furthermore, The SAA concentration change in 9 COVID-19 patients of longitudinal follow-up along with the CT score and SARS-CoV-2 nucleic acid change. In the course of the disease, SAA changes were greater than CRP, lymphocytes, and neutrophils.Conclusions: The serum SAA levels were found to be significantly correlated with impending course of the COVID-19, and may serve as a useful biomarker to monitor the complicated clinical course of the disease.