Serum amyloid A, ferritin and carcinoembryonic antigen as biomarkers of severity in patients with COVID‑19

Abstract

In view of the rapid spread of COVID-19 and the high mortality rate of severe cases, reliable risk stratifying indicators of prognosis are necessary to decrease morbidity and mortality. The aim of the present study was to evaluate the value of serum amyloid A (SAA) and carcinoembryonic antigen (CEA) as prognostic biomarkers in comparison to other predictors, including C-reactive protein (CRP) and ferritin levels. This study included 124 patients diagnosed with COVID-19, and they were assigned to one of two groups: Mild and severe, based on the severity of the infection. Radiological and laboratory investigations were performed, including evaluation of CRP, ferritin, D-Dimer, SAA and CEA levels. Significantly higher levels of CRP, ferritin, D-Dimer, SAA and CEA were observed in severe cases. SAA was significantly correlated with CRP (r= 0.422, P<0.001), ferritin (r= 0.574, P<0.001), CEA (r= 0.514, P<0.001) and computed tomography severity score (CT-SS; r= 0.691, P<0.001). CEA was correlated with CRP (r= 0.441, P<0.001), ferritin (r= 0.349, P<0.001) and CT-SS (r= 0.374, P<0.001). Receiver operator characteristic (ROC) curves for performance of SAA, CEA, ferritin, CRP and SAA showed the highest AUC value of 0.928, with a specificity of 93.1%, and a sensitivity of 98.5% at a cut-off of 16 mg/l. The multi-ROC curve for SAA and ferritin showed 100% specificity, 100% sensitivity and 100% efficiency, with an AUC of 1.000. Thus, combining SAA and ferritin may have guiding significance for predicting COVID-19 severity. SAA alone showed the highest prognostic significance. Both SAA and CEA were positively correlated with the CT-SS. Early monitoring of these laboratory markers may thus provide significant input for halting disease progression and reducing mortality rates.

The utility of serum amyloid A and other acute-phase reactants determination in ambulatory care COVID-19 patients

“…Carubbi et al [36] found that ferritin levels are not associated with a worse prognosis but correlate with the extensiveness of lung involvement. Compared to SAA, ferritin had lower prognostic utility in our study, which is consistent with previous studies [37] [38] . An interesting study by Abdelhakam et al [37] showed that a combination of SAA and ferritin improved the performance characteristics of SAA by increasing AUC from 0.928 to 1.000 and sensitivity from 98.5 to 100%.…”

“…Compared to SAA, ferritin had lower prognostic utility in our study, which is consistent with previous studies [37] [38] . An interesting study by Abdelhakam et al [37] showed that a combination of SAA and ferritin improved the performance characteristics of SAA by increasing AUC from 0.928 to 1.000 and sensitivity from 98.5 to 100%.…”

Elevated Serum Amyloid a Level Predicts Severity of Radiological Lung Involvement in Hospitalized Children With Covid-19

“…Pieri et al 12 detected significant persistent elevation of SAA among non survivors compared to survivors. Abdelhakam et al 25 and Li et al 13 reported significant correlation between SAA and severity of radiological involvement. Our findings pointed out a significant increase in serum amyloid A in all children hospitalized with COVID-19.…”

The Associations of Iron Related Biomarkers with Risk, Clinical Severity and Mortality in SARS-CoV-2 Patients: A Meta-Analysis

“…In all relevant studies, the hemoglobin levels were found to be lower in severe groups than those in controls [7,10,24] or non-severe groups [22,[25][26][27][28][29]. However, in the comparisons between severity [7,10,15,[17][18][19]23,24,[30][31][32][33][34][35][36][37] and mortality [10,30,[38][39][40][41], there was not a consistent numerical magnitude relationship between them. In addition, studies on TIBC [8,10,12,13] and TSAT [8,13] only refer to mortality.…”

“…Lower levels of hepcidin in cases than controls was documented in a study [10], whereas the other studies reported an inverse result [18,20,24]. Unusually, more dangerous groups had higher ferritin levels in almost all relevant comparisons [4,6,[10][11][12][13][14][15][17][18][19][20][21][22][24][25][26][27][28][29][30]32,[34][35][36][37][38][39][40].…”