The value of calprotectin in COVID-19 highlighted at AACC 2020
14. Jan 2021 |
7 min read
How can calprotectin support management of COVID-19 patients?
As hospitals continue to navigate challenges of COVID-19, the availability of intensive care unit (ICU) beds and ventilators remains a critical concern. Research results indicate that calprotectin (measured here in plasma and serum) can be used in the risk assessment and prediction of which COVID-19 patients are at risk of developing severe complications such as respiratory failure and/or mortality. This information can help hospitals to better allocate essential resources that are often in limited supply.
Plasma calprotectin levels are increased in COVID-19 patients admitted to ICU and correlate with endothelial cell damage, in collaboration with Akademiska University Hospital in Uppsala, Sweden
Circulating levels of calprotectin for prediction of disease severity in hospitalised COVID-19 patients, in collaboration with Hospital Universtario Santa Lucia in Spain
Poster: Plasma calprotectin levels are increased in COVID-19 patients admitted to ICU and correlate with endothelial cell damage
This observational study was conducted in collaboration with Akademiska University Hospital in Uppsala, Sweden. The aim of the study was to evaluate performance of calprotectin in prediction of disease severity in ICU-treated COVID-19 patients.
The study included 121 SARS-CoV-2 patients that were admitted to the Akademiska University Hospital ICU, along with ten pre-operative cancer patients being treated at the same ICU who served as controls. The analysis of plasma calprotectin was performed with Gentian’s GCAL® assay, a Particle-Enhanced Turbidimetric Immunoassay (PETIA).
Calprotectin can be used as an early biomarker for neutrophil activation and detection of the hyperinflammatory response in COVID-19 patients
The ICU patients with confirmed COVID-19 had significantly higher plasma calprotectin levels compared with ICU patients without COVID-19.
Results from the study show that calprotectin was able to differentiate between COVID-19 and non-COVID-19 patients with a sensitivity of 93% and a specificity of 100%. Furthermore, calprotectin levels correlated with levels of other inflammatory biomarkers and a biomarker for endothelial cell damage, indicating the prognostic value of calprotectin in subsequent organ failure. As the release of calprotectin from neutrophils is very rapid in response to infections, calprotectin may be used as an early marker for neutrophil activation in COVID-19 infections.
Poster: Circulating levels of calprotectin for prediction of disease severity in hospitalised COVID-19 patients
This prospective, observational study, conducted in collaboration with Santa Lucia University Hospital in Cartagena, Spain, examined the value of serum calprotectin for prediction of in-hospital mortality and need of mechanical ventilation (MV) in 66 patients with confirmed SARS-CoV-2 infection. The analysis of calprotectin was performed with Gentian’s GCAL® assay, a Particle-Enhanced Turbidimetric Immunoassay (PETIA).
The results show that calprotectin levels were significantly higher in COVID-19 patients who required MV and/or died compared to patients with non-severe form of COVID-19. These findings suggest that calprotectin might have a prognostic role in the risk assessment of COVID-19 patients.
For in-hospital mortality, calprotectin showed a good discrimination capacity assessed by the analysis of the AUC of ROC curve, similar to both D-dimer and C-reactive protein (CRP). For calprotectin, optimal cut off to predict in-hospital mortality was 3.9 mg/L and unadjusted Odd Ratio was 13.30 (1.53–116); p = 0.004.
For mechanical ventilation (MV), significant differences were detected for CRP, ferritin and calprotectin, but not for D-dimer. Calprotectin, CRP and ferritin showed a significant accuracy for this outcome. For calprotectin, optimal cutoff to predict need for MV was 2.3 mg/L and unadjusted Odd Ratio was 1.257 (1.082-1.460); p = 0.022. No patient with a serum calprotectin ≤ 2.3 mg/L required MV.
Comparison with other tests for COVID-19 severity assessment
The performance of calprotectin was compared with other tests for COVID-19 severity assessment that are currently in use. Out of the other tests, CRP was the only one that predicted both patients’ need for mechanical ventilation and mortality as accurately as calprotectin.
The important difference between CRP and calprotectin is that calprotectin is a much faster biomarker for inflammation and infection , and therefore an earlier indicator that a patient is getting worse. This means that calprotectin can better suited for making urgent decisions about which COVID-19 patients need to be prioritised and treated with the optimal level of care.
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LabPulse also highlighted Gentian's GCAL® assay in one of their articles from the AACC 2020. In addition to describing calprotectin’s value in COVID-19 patient management, the article also highlighted the significance of having the assay available on clinical chemistry platforms.
Fullerton et al. Meeting abstract P474, 40th International Symposium on Intensive Care & Emergency Medicine. Critical Care. 2020;24(1):87.