In our Frequently Asked Questions about calprotectin series we will answer questions we often receive about plasma and serum calprotectin and the Gentian Calprotectin Immunoassay GCAL®. If you have any additional questions don't hesitate to contact us on firstname.lastname@example.org.
In this section we will look into why plasma and serum calprotectin is upregulated in COVID-19?
Plasma and serum calprotectin has been described as specific biomarker for the inflammatory response in severe bacterial infections and sepsis, where it is able to distinguish between viral and bacterial infections1-3. But why is it upregulated in the viral infection COVID-19 and what is the link to sepsis?
SARS-CoV-2 has been described to cause viral sepsis in several studies4-9. This is also reported by the Global Sepsis Alliance. Patients with severe COVID-19 have shown symptoms of sepsis and septic shock, including including fever and chills, fatigue or weakness, cold extremities and weak peripheral pulses. Hospitalised COVID-19 patients with severe form of the disease have also alterations in the coagulation, dysregulated immune response and induction of cytokine response also called cytokine storm, the response which is very similar to bacterial sepsis6,10-13. In fact, many severe COVID-19 patients meet the criteria of the Third International Consensus Definitions for Sepsis (Sepsis‐3). Most of COVID-19 deaths are caused by sepsis7,10,14.
SARS-CoV-2 infections differ from other viral infections because severe COVID-19 patients display symptoms of immune dysregulation and hyperinflammation15. The cytokine storm is described in many severe COVID-19 patients. It is characterised by a high production of cytokines resulting in increased inflammation7,8,11,16.
Neutrophils are upregulated and activated in COVID-19 patients as potential driver of disease severity15,17,18. Calprotectin is marker for neutrophil activation19,20 and has also been shown to correlate with increased cytokines in COVID-1921.
In the light of the similarities of bacterial and viral sepsis, it is sensible that calprotectin, as biomarker in bacterial sepsis22-24, is elevated in severe COVID-19. Indeed, calprotectin has been reported to be elevated in COVID-19 patients correlating with disease severity, and plasma and serum calprotectin has been described as promising biomarker for risk stratification21, 25-29.
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