Circulating adipokine levels and COVID-19 severity in hospitalized patients

Abstract

Background Obesity is a risk factor for adverse outcomes in COVID-19, potentially driven by chronic inflammatory state due to dysregulated secretion of adipokines and cytokines. We investigated the association between plasma adipokines and COVID-19 severity, systemic inflammation, clinical parameters, and outcome of COVID-19 patients. Methods In this multi-centre prospective cross-sectional study, we collected blood samples and clinical data from COVID-19 patients. The severity of COVID-19 was classified as mild (no hospital admission), severe (ward admission), and critical (ICU admission). ICU non-COVID-19 patients were also included and plasma from healthy age, sex, and BMI-matched individuals obtained from Lifelines. Multi-analyte profiling of plasma adipokines (Leptin, Adiponectin, Resistin, Visfatin) and inflammatory markers (IL-6, TNFα, IL-10) were determined using Luminex multiplex assays. Results Between March and December 2020, 260 SARS-CoV-2 infected individuals (age: 65 [56–74] BMI 27.0 [24.4–30.6]) were included: 30 mild, 159 severe, and 71 critical patients. Circulating leptin levels were reduced in critically ill patients with a high BMI yet this decrease was absent in patients that were administered dexamethasone. Visfatin levels were higher in critical COVID-19 patients compared to non-COVID-ICU, mild and severe patients (4.7 vs 3.4, 3.0, and 3.72 ng/mL respectively, p < 0.05). Lower Adiponectin levels, but higher Resistin levels were found in severe and critical patients, compared to those that did not require hospitalization (3.65, 2.7 vs 7.9 µg/mL, p < 0.001, and 18.2, 22.0 vs 11.0 ng/mL p < 0.001). Conclusion Circulating adipokine levels are associated with COVID-19 hospitalization, i.e., the need for oxygen support (general ward), or the need for mechanical ventilation and other organ support in the ICU, but not mortality.

Adipokines as Diagnostic and Prognostic Markers for the Severity of COVID-19

“…Hence, it remains to be clarified if circulating leptin levels are associated with BMI in SARS-CoV-2-infected patients. Furthermore, adding to the uncertainty in the field, another study could not detect major differences in plasma leptin levels between healthy controls and patients with mild, severe, and critical COVID-19 [76]. Likewise, and in contrast to the studies described above [71,73,108,118,119], systemic leptin levels were comparable in patients with mild, moderate, and severe COVID-19 disease [68].…”

“…Notably, the healthy controls were sex, age, and BMI matched to the COVID-19 patients admitted to the intensive care unit. Critically ill COVID-19 patients were generally older, often male, and had a higher BMI compared to patients with mild disease outcome [76].…”

Exercise is the Most Important Medicine for COVID-19

“…Exercise may help reduce chronic inflammation (that occurs with long COVID), as a result of IL-6 (myokine) enhancing lipolysis and fat oxidation (reducing visceral fat), via a mechanism that involves AMPK activation (52). Reducing adiposity may be beneficial to attenuating the effects of COVID-19, as circulating adipokine levels have been associated with COVID-19 hospitalization, but not mortality (53). Although vigorous exercise may induce short-term inflammatory effects, the overall effect of a moderate intensity exercise bout, is anti-inflammatory (42).…”

Neutrophil degranulation, endothelial and metabolic dysfunction in unvaccinated long COVID patients

“…15 Potential candidates are a number of molecules involving neutrophil degranulation, [16][17][18] endothelial [19][20][21] and metabolic dysfunction (i.e. adipokines [22][23][24][25] ), but the ultimate role of such mediators is still unclear.…”