The prognostic role of neopterin in COVID‐19 patients

Abstract

In Coronavirus disease‐2019 (COVID‐19) cases, hyper inflammation is associated with the severity of the disease. High levels of circulating cytokines were reported in severe COVID‐19 patients. Neopterin produced by macrophages on stimulation with interferon‐gamma, which is an important cytokine in the antiviral immune response, hence it can be used to predict the severity of disease in COVID‐19 cases. In this study, it was aimed to determine the prognostic value of the neopterin for the prediction of severe disease in patients with COVID‐19. This single‐center, prospective study was conducted in hospitalized COVID‐19 patients and healthy volunteers. Severe and mild COVID‐19 cases were compared in terms of clinical and laboratory findings as well as serum neopterin levels on hospital admission. To assess the prognostic utility of neopterin between the severe and mild COVID‐19 groups, a receiver‐operating characteristic (ROC) curve was generated, and the area under the curve (AUC) was calculated. The median serum neopterin level was four times higher in COVID‐19 patients than the healthy controls (46 vs. 12 nmol/L; p < .001). The AUC value of serum neopterin was 0.914 (95% confidence interval, 0.85–0.97). The sensitivity and specificity of serum neopterin for the cut‐off value of 90 nmol/L to identify severe COVID‐19 cases were 100% and 76%, respectively. Serum neopterin levels on hospitalization were significantly higher in severe COVID‐19 disease than mild COVID‐19 patients. Neopterin levels can be used as an early prognostic biomarker for COVID‐19 on admission.

Serum neopterin levels in relation to mild and severe COVID-19

“…In that study, higher neopterin levels were associated with a longer fever period, as well as a severer course of disease. Moreover, a recent report on hospitalized COVID-19 patients showed that neopterin levels were significantly Means and standard deviations (SD) are shown KYN/TRP kynurenine to tryptophan ratio, IFN-y interferon-gamma higher in severe cases compared to mild cases [15]. Besides supporting these findings, our study adds the trajectory of neopterin levels with repeated measurements, where we found that most patients with mild symptoms returned to normal neopterin levels at the end of the study period.…”

Neopterin: A Promising Candidate Biomarker for Severe COVID-19

“… 57 Likewise, a similar report showed that patients with severe COVID-19 had higher levels compared with mild cases on hospital admission and a four-fold increase compared with healthy controls. 58 …”

Laboratory diagnostic value of neopterin measurements in patients with COVID-19 infection

“…Neopterin (D-erythro-1'2'3'-trihydroxypropylpterin) of other species are less able of doing so. In patients, increased neopterin concentrations were documented in body fluids like serum, urine and cerebrospinal fluid (CSF), e.g., during cytokine therapies but also in diseases that are associated with activation of the Th1-type immune system such as mycobacterial infections, autoimmune pathologies and various forms of cancer and with viral infections including HIV-1 and SARS-CoV-1 [3,10,11] and recently also with SARS-CoV-2 [4][5][6].…”

“…Similar to HIV-1 infection, elevated neopterin concentrations in serum and CSF are common also in patients with SARS-CoV-2 infection, and are predictive for the course of the infection [4][5][6]. However, in SARS-CoV-2 infection, an unusual pattern of CSF inflammation is commonly present with increased soluble markers like neopterin and beta2-microglobulin while white cell response and other immunologic features typical of CNS viral infections are absent [5].…”

“…There is limited information about prognostic markers that could help clinicians to identify COVID-19 patients that are likely to develop a poor outcome. The serum levels of the immune activation marker neopterin have shown to be of prognostic value in patients with SARS-CoV-1 [3] and first studies provide hints that serum neopterin could be helpful in stratifying SARS-CoV-2 patients [4][5][6]. The aim of this commentary was to investigate whether neopterin measurements are of clinical value in COVID-19 patients.…”