Role of cystatin C and calprotectin as potential early prognostic biomarkers in COVID-19 patients admitted to a dedicated COVID care facility

Abstract

Background: The COVID-19 pandemic has claimed millions of lives. A tool for early prediction of severity and mortality risk is desirable for better utilization of health care facilities. Several biomarkers like D-dimer, lactate dehydrogenase (LDH), C-reactive protein (CRP) and some recently explored biomarkers like serum cystatin C and serum calprotectin have been proposed as prognostic markers of COVID-19, but their role as prognostic markers is so far undefined. The present work attempted to investigate the possible role of serum cystatin C and serum calprotectin as prognostic tools to predict severity and outcome ahead of time. Material and Methods: This observational cohort study was carried out on 95 COVID-19 patients admitted to a dedicated COVID care facility from mid-October 2020 to January 2021. Serial estimations of serum cystatin C and serum calprotectin levels were done and assessed for significant difference between severe (NEWS 2 score ≥5) and non-severe (NEWS 2 score <5) groups, survivors and deceased and on the basis of comorbidities at each time points. Survival analysis was done based on the optimal thresholds for severity and mortality, calculated from the receiver operating characteristic (ROC). Result: The results showed that median cystatin C levels were significantly higher on the first day in the severe group ( P < 0.001) and in patients with cardiovascular disease ( P < 0.05), chronic lung disease ( P = 0.009) and among patients who died ( P < 0.05). It remained raised on day 3 in severe ( P < 0.05) and deceased ( P < 0.05) group. Serum calprotectin levels were significantly higher in patients with chronic lung disease ( P = 0.008) and in those who died ( P < 0.05). Conclusion: Serum cystatin C could be used as a tool for early prognosis and therapeutic decision-making for COVID-19 patients. Serum calprotectin seems to be a better marker of critical illness.

Prognostic Performance of Cystatin C in COVID-19: A Systematic Review and Meta-Analysis

“…Two hundred ninety-three duplicates were removed, and the remaining 131 articles were screened by title and abstract, which resulted in the exclusion of 92 irrelevant articles. Full-text screening was performed on 39 studies, and data for 25 studies were extracted for this meta-analysis [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. Figure 1 depicts the various exclusions and selection procedures.…”

“…The systematic review included articles published between 2020 and 2022, comprising a total of 3916 COVID-19 participants ( Table 1 ). The final set considered of 25 eligible studies [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ], including 18 articles conducted in China [ 21 , 22 , 23 , 25 , 26 , 27 , 28 , 31 , 33 , 34 , 36 , 37 , 38 , 39 , 41 , 42 , 43 , 44 ], two articles in Turkey [ 32 , 40 ], and one article each from the following countries: Iraq [ 20 ], India [ 24 ], Mexico [ 29 ], USA [ 30 ] and Egy...…”

“…The results of our meta-analysis show the potential clinical role of Cystatin C in predicting severe COVID-19 in patients. Serum Cystatin C concentrations in particular were linked to COVID-19 mortality [ 21 , 24 , 26 , 27 , 28 , 29 , 35 , 36 , 39 , 42 ], severity [ 20 , 22 , 23 , 24 , 27 , 28 , 31 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 41 , 42 , 43 , 44 ], and the onset of acute kidney injury [ 29 , 30 , 35 , 40 ].…”

“…The diamonds represent pooled results. Legend: CI: confidence interval; SD: standard deviation [ 20 , 22 , 23 , 24 , 27 , 28 , 31 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 41 , 42 , 43 , 44 ].…”

Role of Hematological Parameters in the Grading of COVID-19 and a Model to Predict the Outcome in Inpatients

“…The rationale behind its inclusion lies in its well-established reputation as a standardized and widely accepted clinical tool for assessing illness severity and predicting patient outcomes, particularly in acute care settings. Patients with NEWS scores ranging from 1 to 4 were categorized as non-severe, while those with scores of 5 and above were classified as severe [ 19 ].…”