Utility of P-SEP, sTREM-1 and suPAR as Novel Sepsis Biomarkers in SARS-CoV-2 Infection

Abstract

The coronavirus disease 2019 is a highly contagious viral infection caused by SARS-CoV-2 virus, member of coronaviridae family. It causes life threatening complications due to complexity and rapid onset course of the disease. Early identification of high-risk patients who require close monitoring and aggressive treatment remains challengeable till date. Novel biomarkers which help to identify high risk patients at the early stage is high priority. Objective of this review to find utility of P-SEP, sTREM-1 and suPAR for diagnosis, risk stratification and prognosis of SARS-CoV-2 infected cases. Soluble receptors like, P-SEP, sTREM-1 and suPAR have been involved in immune regulation in SARS-CoV-2 infection and elevate more in severe cases. A comprehensive research of databases like PubMed, EMBASE, CNKI and Web of Science was performed for relevant studies. A total of nine out of fifteen research literature in initial screening were included for this review. Interestingly all studies have reported high levels of P-SEP, sTREM-1 and suPAR in SARS-CoV-2 infected cases and the biomarkers positively correlated with severity of infection. This implies that P-SEP, sTREM-1 and suPAR can be implemented as surrogate marker in blood profile for early diagnosis, risk stratification and prognosis in SARS-CoV-2 for better management in Indian population at the current situation.converting enzyme 2 Covid-2019 Coronavirus disease 2019 DIC Disseminated intravascular coagulation ORF Open reading frame SARS-CoV-2 Severe acute respiratory syndrome coronavirus-2 sTREM-1 Soluble triggering receptor expressed on myeloid cells suPAR Soluble Urokinase-type plasminogen activator receptor TMPRSS2 Transmembrane protease, serine 2

Novel inflammatory biomarkers in the prognosis of COVID-19

“…In previous studies, suPAR was mainly used as a biomarker of kidney injury and inflammation, 40 and more recently, as a biological indicator to predict disease severity or poor prognosis in COVID-19 patients. [41][42][43] The soluble receptor for advanced glycation endproducts (sRAGE) is a well-characterized marker of lung alveolar epithelial injury, and its importance in ARDS patients has been proven to correlate with prognostic and pathogenic values. 49,50 The sRAGE can directly or indirectly combine with different types of ligands and stimulate RAGE-associated inflammatory pathways.…”

“…In previous studies, suPAR was mainly used as a biomarker of kidney injury and inflammation, 40 and more recently, as a biological indicator to predict disease severity or poor prognosis in COVID-19 patients. 41–43 Alfano et al explained the association of suPAR with viral pathogenesis mechanisms, including the involvement of suPAR in S protein cleavage, and fibrinolytic balance. 9,44 Rovina et al noted that suPAR is an early predictor of the development of severe respiratory failure (SRF) 45 and that higher plasma suPAR levels predict the risk of kidney disease in patients with COVID-19.…”

Validation of sTREM-1 and IL-6 based algorithms for outcome prediction of COVID-19

“…Increased sTREM-1 levels are associated with poor clinical outcome in patients with COVID-19, as shown in various studies and a meta-analysis. It is therefore a good candidate as triage tool [ 4 – 6 , 11 – 13 ]. IL-6 plays a role in the genesis of the pro-inflammatory lung-systemic loop leading to a cytokine storm syndrome and acute respiratory distress syndrome [ 14 ].…”

A comparative analysis of serial measurements of Soluble Urokinase-type Plasminogen Activator Receptor (suPAR) and C-reactive protein in patients with moderate COVID-19: a single center study from India

“…We observed that all those patients who died had progressed to severe COVID and developed ARDS. Chen D et al, 2019 observed serum suPAR levels predicted increased risk of ARDS in patients with sepsis [21]. Furthermore, its upregulation was observed to be directly proportionate with higher disease severity, inflammation and increased mortality in patients with sepsis and ARDS [22].…”