Elevated Neopterin Levels Predict Fatal Outcome in SARS-CoV-2-Infected Patients

Abstract

HighlightsInnate immune activation during Covid-19 infection is associated with pernicious clinical outcome.BackgroundCoronavirus disease 2019 (Covid-19) is a worldwide threat that has already caused more than 3 000 000 deaths. It is characterized by different patterns of disease evolution depending on host factors among which old-age and pre-existing comorbidities play a detrimental role. Previous coronavirus epidemics, notably SARS-CoV, were associated with increased serum neopterin levels, which can be interpreted as a sign of acute innate immunity in response to viral infection. Here we hypothesize that neopterin may serve as a biomarker of SARS-CoV-2 viral infection and Covid-19 disease severity.MethodsWe measured neopterin blood levels by ELISA. Seric concentration was quantified from 256 healthy donors and 374 Covid-19 patients at hospital admission. Enrolled Covid-19 patients were all symptomatic and displayed a large spectrum of comorbidities. Patients were followed until disease resolution or death.ResultsSevere and critically ill SARS-CoV-2 infected patients were characterized by a profound exacerbation of immune activation characterized by elevated neopterin blood levels. Systemic neopterin levels above 19nM stratified healthy individuals from Covid-19 patients with 87% specificity and 100% sensitivity. Moreover, systemic neopterin levels above 53nM differentiated non-survivors from survivors with 64% specificity and 100% sensitivity.ConclusionWe propose that neopterin concentration measured at arrival to hospital is a hallmark of severe Covid-19 and identifies a high-risk population of pernicious clinical outcome with a need for special medical care.

Assessment of serum neopterin and calprotectin as biomarkers for subclinical inflammation in patients with familial Mediterranean fever

“…These data have gained importance in an era characterized by new immunotherapeutic agents’ advent. Notably, NPT has been correlated to the clinical progression of patients infected with SARS-CoV [ 36 ]. NPT was also related to disease activity in RA patients.…”

Corona and Reproduction, or Why the Corona Vaccination Does Not Result in Infertility

“…Trotz gleicher Prävalenz besteht sowohl bezüglich der Schwere der Erkrankung als auch der Mortalität ein deutlicher Geschlechter-Bias 3 , 4 : Männer weisen ein höheres Risiko für eine Atemwegsintubation und eine längere stationäre Verweildauer als Frauen auf. Zusätzlich besteht bei Männern eine höhere Sterblichkeitsrate, auch im Vergleich der Altersgruppen, der Ethnizitäten und unter Einschluss der Komorbiditäten 5 .…”

“…Although the prevalence of disease has been approximately the same, a significant gender bias has been found with regard to both severity of disease and mortality 3 , 4 : men have a higher risk of requiring intubation and spend a longer time in hospital compared to women. In addition, the mortality rate in men is higher, even after comparing age groups and ethnicities and taking co-morbidities into account 5 .…”

Estimation of Salivary Neopterin Levels in Aggressive and Chronic Periodontitis After Nonsurgical Periodontal Therapy: A Cohort Study

“…6 Recent evidence also indicates an association between the severity of inflammation in SARS CoV-2 infection and neopterin levels characterized by a profound exacerbation of immune activation. 7,8 Although serum and gingival crevicular fluid (GCF) is an ideal medium to assess the biological indicators, saliva is appealing to use in oral-related diseases because of its easy and noninvasive nature in terms of its collection and its abundant nature. It is believed that the measurement of neopterin in saliva might be useful for diagnosing and predicting the prognosis of periodontal disease because it has been well-documented that T cells in addition to other inflammatory infiltrates, mediate the immunopathological events in periodontal disease.…”