Early Routine Biomarkers of SARS-CoV-2 Morbidity and Mortality: Outcomes from an Emergency Section
Flavio Maria Ceci,
Marco Fiore,
Francesca Gavaruzzi,
Antonio Angeloni,
Marco Lucarelli,
Carolina Scagnolari,
Enea Bonci,
Francesca Gabanella,
Maria Grazia Di Certo,
Christian Barbato,
Carla Petrella,
Antonio Greco,
Marco De Vincentiis,
Massimo Ralli,
Claudio Passananti,
Roberto Poscia,
Antonio Minni,
Mauro Ceccanti,
Luigi Tarani,
Giampiero Ferraguti
Affiliations
Flavio Maria Ceci
Department of Experimental Medicine, Sapienza University of Rome, 00185 Roma, Italy
Marco Fiore
Institute of Biochemistry and Cell Biology (IBBC-CNR), Department of Sensory Organs, Sapienza University of Rome, 00185 Roma, Italy
Francesca Gavaruzzi
Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy
Antonio Angeloni
Department of Experimental Medicine, Sapienza University of Rome, 00185 Roma, Italy
Marco Lucarelli
Department of Experimental Medicine, Sapienza University of Rome, 00185 Roma, Italy
Carolina Scagnolari
Laboratory of Virology, Department of Molecular Medicine, Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Sapienza University of Rome, 00185 Roma, Italy
Enea Bonci
Department of Experimental Medicine, Sapienza University of Rome, 00185 Roma, Italy
Francesca Gabanella
Institute of Biochemistry and Cell Biology (IBBC-CNR), Department of Sensory Organs, Sapienza University of Rome, 00185 Roma, Italy
Maria Grazia Di Certo
Institute of Biochemistry and Cell Biology (IBBC-CNR), Department of Sensory Organs, Sapienza University of Rome, 00185 Roma, Italy
Christian Barbato
Institute of Biochemistry and Cell Biology (IBBC-CNR), Department of Sensory Organs, Sapienza University of Rome, 00185 Roma, Italy
Carla Petrella
Institute of Biochemistry and Cell Biology (IBBC-CNR), Department of Sensory Organs, Sapienza University of Rome, 00185 Roma, Italy
Antonio Greco
Department of Sensory Organs, Sapienza University of Rome, 00185 Roma, Italy
Marco De Vincentiis
Department of Sensory Organs, Sapienza University of Rome, 00185 Roma, Italy
Massimo Ralli
Department of Sensory Organs, Sapienza University of Rome, 00185 Roma, Italy
Claudio Passananti
Institute of Molecular Biology and Pathology (IBPM-CNR), 00185 Rome, Italy
Roberto Poscia
Unita di Ricerca Clinica e Clinical Competence-Direzione Generale, AOU Policlinico Umberto I, 00161 Roma, Italy
Antonio Minni
Department of Sensory Organs, Sapienza University of Rome, 00185 Roma, Italy
Mauro Ceccanti
Società Italiana per il Trattamento dell’Alcolismo e le sue Complicanze (SITAC), 00184 Roma, Italy
Luigi Tarani
Department of Pediatrics, Sapienza University of Rome, 00185 Roma, Italy
Giampiero Ferraguti
Department of Experimental Medicine, Sapienza University of Rome, 00185 Roma, Italy
Background. COVID-19 is a severe acute respiratory disease caused by SARS-CoV-2, a virus belonging to the Coronaviridae family. This disease has spread rapidly around the world and soon became an international public health emergency leading to an unpredicted pressure on the hospital emergency units. Early routine blood biomarkers could be key predicting factors of COVID-19 morbidity and mortality as suggested for C-reactive protein (CRP), IL-6, prothrombin and D-dimer. This study aims to identify other early routine blood biomarkers for COVID-19 severity prediction disclosed directly into the emergency section. Methods. Our research was conducted on 156 COVID-19 patients hospitalized at the Sapienza University Hospital “Policlinico Umberto I” of Rome, Italy, between March 2020 and April 2020 during the paroxysm’s initial phase of the pandemic. In this retrospective study, patients were divided into three groups according to their outcome: (1) emergency group (patients who entered the emergency room and were discharged shortly after because they did not show severe symptoms); (2) intensive care unit (ICU) group (patients who attended the ICU after admission to the emergency unit); (3) the deceased group (patients with a fatal outcome who attended the emergency and, afterward, the ICU units). Routine laboratory tests from medical records were collected when patients were admitted to the emergency unit. We focused on Aspartate transaminase (AST), Alanine transaminase (ALT), Lactate dehydrogenase (LDH), Creatine kinase (CK), Myoglobin (MGB), Ferritin, CRP, and D-dimer. Results. As expected, ANOVA data show an age morbidity increase in both ICU and deceased groups compared with the emergency group. A main effect of morbidity was revealed by ANOVA for all the analyzed parameters with an elevation between the emergency group and the deceased group. Furthermore, a significant increase in LDH, Ferritin, CRP, and D-dimer was also observed between the ICU group and the emergency group and between the deceased group and ICU group. Receiver operating characteristic (ROC) analyses confirmed and extended these findings. Conclusions. This study suggests that the contemporaneous presence of high levels of LDH, Ferritin, and as expected, CRP, and D-dimer could be considered as potential predictors of COVID-19 severity and death.
