Galectin-3 as Prognostic Predictor in Patients with COVID-19 Acute Respiratory Failure

Abstract

Background. Galectin-3 is β-galactoside-binding lectin with several roles in immune-inflammatory response. To date, there is no evidence of Galectin-3 role as a prognostic predictor in COVID-19 disease. The aim of this study is to clarify the prognostic role of Galectin-3 in patients with COVID 19 acute respiratory failure.Methods. We enrolled 156 consecutive patients with COVID-19 disease. Routine laboratory test, arterial blood gas, chest X-ray or Computed Tomography and Galectin-3 dosage were performed. The primary outcome was to assess Galectin-3 predictive power for 30-day mortality. Secondary outcomes were 30-day Intensive Care Unit admission and Acute Respiratory Distress Syndrome stratification according to Galectin-3 dosage. We performed Mann-Whitney U and Kruskal-Wallis tests for continuous variables comparison. Fisher’s exact test or Chi-square test were used for categorical variables analysis. Relationships between Galectin-3, clinical and laboratory data were identified using Spearman analysis. Receiver Operating Characteristic curves estimated Galectin-3 predictive power for the endpoints. With a fixed cut-off of 35.3 ng/ml, Kaplan-Meier with Log-Rank test and Cox Regression were performed to assess mortality and Intensive Care Unit admission risk. Results. Galectin-3 correlated with many other prognostic predictors tested in our analysis. Moreover, patients with serum levels of Galectin-3 above 35.3 ng/ml had increased risk for mortality, Intensive Care Unit admission and severe Acute Respiratory Distress Syndrome. Conclusions. Our study demonstrates the role of Galectin-3 as a predictor of mortality, Intensive Care Unit access and ARDS stratification in patients with COVID 19 acute respiratory failure.

Galectins can serve as biomarkers in COVID-19: A comprehensive systematic review and meta-analysis

“…With an area under the curve (AUC) of 0.622, Karsli et al ( 33) reported Gal-3 as a potential biomarker for the diagnosis of COVID-19. Prediction of ICU admission based on Gal-3 showed an AUC of 0.7 in the Portacci et al study (7), and 0.802 in Ozcan et al study (36). Moreover, the threshold of 15.51 ng/ml resulted in a sensitivity of 78% and specificity of 90% in the prediction of ICU admission, according to Kusnierz-Cabala et al (34).…”

“…The prediction of in-hospital mortality reported an AUC of 0.843 with sensitivity and specificity of 75% and 76.8%, respectively (36). The 30-day mortality prediction showed an AUC of 0.906 and 0.681 in studies by Portacci et al (7) and Tawiah et al (38). A study conducted by Rodrı ́guez-Tomàs et al (37) reported an AUC of 0.709 in differentiating COVID-19 patients from controls.…”

“…After removing duplicates, 524 records were screened by titles and abstracts. Following this step, 63 studies were evaluated by full texts, resulting in 18 final included studies (7,(19)(20)(21)(22)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) flow chart summarizing the selection process is available in Figure 1.…”

“…For instance, studies have demonstrated that in patients with a higher severity level of COVID-19 pneumonia, increased serum levels of C-reactive protein, interleukin-10, and interleukin-6/Interferon-g ratio were frequently found (4)(5)(6). In addition, others reported that blood levels of D-dimer, lactate dehydrogenase, and white blood cell count played a role in predicting adverse outcomes in the severe COVID-19 (7).…”

“…that COVID-19 cases with a composite endpoint had significantly higher levels of Gal-3 (12.1 [10.3-15.9] ng/ml vs. 8.1[6.5-11.3] ng/ml, P < 0.001). The outcome of death was the case investigated in studies by Portacci et al(7) and Tawiah et al(38). Portacci et al reported median Gal-3 as 43.8 [36.2-59] ng/ml in dead patients, which was significantly higher than the ones with 30-…”