When patients with COVID-19 arrive in emergency rooms, there are relatively few ways for doctors to predict which ones are more likely to become critically ill and require intensive care and which ones are more likely to enjoy a quick recovery.
In a new study, researchers found that a series of biomarkers, or biological signals, linked to white blood cell activation and obesity can predict severe outcomes in COVID-19 patients.
They found patients with high levels of these markers were much more like to require care in the intensive care unit, require ventilation, or die due to their COVID-19.
The research was conducted by a team at Yale.
Previously, a few studies had identified possible indicators of severe COVID-19, including D-dimer levels, a measure of blood coagulation, and levels of proteins known as cytokines, which are released as part of inflammatory responses in the body.
However, until now, no laboratory marker could predict which patients with COVID-19 would eventually become critically ill prior to showing clinical signs and symptoms of severe disease.
In the study, the team analyzed samples taken from 100 patients who would go on to experience different levels of COVID-19 severity.
In all cases, the blood samples were collected on the patients’ first day of admission.
The researchers also analyzed clinical data for over 3,000 additional patients with COVID-19 within the Yale New Haven Hospital system.
They found that five proteins (resistin, lipocalin-2, HGF, IL-8, and G-CSF) that are linked to neutrophils, a type of white blood cell, were elevated in the COVID-19 patients who later became critically ill.
Many of these proteins had previously been associated with obesity but not with COVID-19 or other viral illnesses.
Notably, the elevated neutrophil biomarkers for patients who would go on to experience more serious symptoms were evident before those symptoms appeared.
All COVID-19 patients who were admitted or transferred to the ICU had elevated neutrophil activation markers, while these biomarkers remained low for patients who never developed the severe illness. None of the patients with lower neutrophil biomarker levels died.
This study is one of the first demonstrations that a set of biomarkers in the blood of COVID patients can predict eventual ICU admission, even before such patients become critically ill.
Having early knowledge of these indicators could strongly improve patient treatment.
One author of the study is Dr. Hyung Chun, an associate professor of medicine in cardiovascular medicine and pathology.
The study is published in Blood Advances.
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