Circulating levels of calprotectin, a signature of neutrophil activation in prediction of severe respiratory failure in COVID-19 patients: a multicenter, prospective study (CalCov study)

Abstract

Objective Severe COVID-19 is characterized by a dysregulated immune response in which neutrophils play a critical role. Calprotectin reflects neutrophil activation and is involved in the self-amplifying thrombo-inflammatory storm in severe COVID-19. We aimed to evaluate the role of calprotectin in early prediction of severity in COVID-19 patients. Methods This was a multicenter prospective observational study enrolling consecutive adult COVID-19 patients. On arrival to emergency department, blood samples were collected for laboratory tests, including serum calprotectin. The primary outcome was severe respiratory failure requiring invasive mechanical ventilation and the secondary outcome was need for Intensive Care Unit (ICU) admission. Results Study population included 395 patients, 57 (14.4%) required invasive mechanical ventilation and 100 (25.3%) were admitted to ICU. Median serum calprotectin levels were significantly higher in intubated (3.73 mg/L vs. 2.63 mg/L; p < 0.001) and ICU patients (3.48 mg/L vs. 2.60 mg/L; p = 0.001). Calprotectin showed a significant accuracy to predict the need for invasive mechanical ventilation (ROC AUC 0.723) and ICU admission (ROC AUC 0.650). In multivariate analysis, serum calprotectin was an independent predictor of invasive mechanical ventilation (OR 1.161) and ICU admission (OR 1.068). Conclusion Serum calprotectin can be used as an early predictor of severity in COVID-19 patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00011-021-01516-4.

Dynamics of circulating calprotectin accurately predict the outcome of moderate COVID-19 patients

“…COVID-19 pandemic promoted the development of easy-to-implement assays to measure calprotectin in routine biology. These assays correlated the circulating amount of calprotectin measured at diagnosis with COVID-19 severity, 6 , 10 , 11 , 12 which was recently confirmed in a meta-analysis. 13 Nevertheless, the predictive value of baseline calprotectin amount was challenged in ambulatory adult patients 14 and the question remains open on whether calprotectin trajectory could better inform on the risk of clinical switch from a moderate to a severe form of COVID-19, guiding therapeutic strategy and adaptation.…”

Calprotectin Levels and Neutrophil Count Are Prognostic Markers of Mortality in COVID-19 Patients

“…A further study [ 23 ] did not find this kind of association probably due to the low number of studied patients ( n = 19). Several other studies also revealed the predictive role of high calprotectin levels toward COVID-19 severity [ 24 , 25 , 26 ]. In addition, several other studies were focused on the predictive role of calprotectin toward COVID-19 severity revealing.…”

The mosaic of autoimmunity – Finally discussing in person. The 13th international congress on autoimmunity 2022 (AUTO13) Athens

“…Interestingly, higher levels of cCLP were detected in severely ill patients and those who were admitted to the intensive care unit. In a different study of patients arriving to emergency department, a similar conclusion was drawn, where cCLP could be used as an early predictor for COVID-19 severity [ 59 ]. Thyroid autoimmunity and COVID-19 association was discussed by Kostoglou-Athanassiou who presented a 50-year-old patient who developed subacute thyroiditis 2 months following a mild SARS-CoV-2 infection, as well as a case of a 53-year-old male patient who developed subacute thyroiditis 3 days following COVID-19 vaccination.…”