Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
BMC Infect Dis. 2020 Dec 10;20(1):942. doi: 10.1186/s12879-020-05671-7.
The COVID-19 pandemic, caused by the coronavirus SARS-CoV-2, is rapidly spreading worldwide. There is limited information about prognostic markers that could help clinicians to identify COVID-19 patients with a poor prognosis. Serum levels of the immune activation marker neopterin has shown to be of prognostic value in patients with SARS. The aim of this study was to investigate whether serum neopterin is associated with the severity of COVID-19.
We included 34 patients with confirmed COVID-19 between March 3 and March 30, 2020. Fifteen patients had mild disease and did not require hospitalization, whereas 19 patients developed severe COVID-19 requiring intensive care. Concentrations of serum neopterin, tryptophan, and kynurenine were measured at and repeatedly after inclusion.
We found a more than two-fold higher mean concentration of neopterin in severely ill patients (mean value 42.0 nmol/L (SD 18.2)) compared to patients with mild symptoms (16.9 nmol/L (SD 11.0)). All of the severe cases had elevated neopterin concentrations (> 9.1 nmol/L) at the initial sampling with values ranging from 17.2 to 86.7 nmol/L. In comparison, 10 of 15 patients with mild disease had neopterin levels above 9.1 nmol/L, with concentrations in the range from 4.9 to 31.6 nmol/L. Neopterin levels gradually decreased during the course of COVID-19, but severe cases maintained elevated levels for a longer period. Moreover, lower levels of tryptophan and higher levels of kynurenine, indicating an increased tryptophan catabolism, were seen in the group with severe cases.
In conclusion, we found that serum neopterin levels are associated with the severity of COVID-19. Our findings suggest that neopterin could be used as a prognostic marker, but further studies are needed to elucidate how it can be used in the clinic.
由冠状病毒 SARS-CoV-2 引起的 COVID-19 大流行正在全球迅速蔓延。目前关于能够帮助临床医生识别预后不良的 COVID-19 患者的预后标志物的信息有限。免疫激活标志物血清中新蝶呤在 SARS 患者中的预后价值已得到证实。本研究旨在探讨血清新蝶呤是否与 COVID-19 的严重程度相关。
我们纳入了 2020 年 3 月 3 日至 3 月 30 日期间确诊的 34 例 COVID-19 患者。15 例患者为轻症，无需住院，19 例患者发展为需要重症监护的重症 COVID-19。在纳入时及之后多次测量血清新蝶呤、色氨酸和犬尿氨酸的浓度。
我们发现，重症患者的新蝶呤平均浓度高出两倍以上（平均值 42.0 nmol/L（SD 18.2）），而症状较轻的患者为 16.9 nmol/L（SD 11.0）。所有重症病例在初次采样时均有升高的新蝶呤浓度（>9.1 nmol/L），范围为 17.2 至 86.7 nmol/L。相比之下，15 例轻症患者中有 10 例的新蝶呤水平高于 9.1 nmol/L，范围为 4.9 至 31.6 nmol/L。新蝶呤水平在 COVID-19 期间逐渐下降，但重症病例的升高水平持续时间更长。此外，在重症组中还观察到色氨酸水平降低和犬尿氨酸水平升高，表明色氨酸分解代谢增加。
总之，我们发现血清新蝶呤水平与 COVID-19 的严重程度相关。我们的研究结果表明，新蝶呤可用作预后标志物，但需要进一步研究阐明其在临床上的应用。
