Neutrophil calprotectin identifies severe pulmonary disease in COVID-19

H Shi, Y Zuo, S Yalavarthi, K Gockman… - Journal of Leucocyte …, 2021 - academic.oup.com
H Shi, Y Zuo, S Yalavarthi, K Gockman, M Zuo, JA Madison, C Blair, W Woodward, SP Lezak…
Journal of Leucocyte Biology, 2021academic.oup.com
Severe cases of coronavirus disease 2019 (COVID-19) are regularly complicated by
respiratory failure. Although it has been suggested that elevated levels of blood neutrophils
associate with worsening oxygenation in COVID-19, it is unknown whether neutrophils are
drivers of the thrombo-inflammatory storm or simple bystanders. To better understand the
potential role of neutrophils in COVID-19, we measured levels of the neutrophil activation
marker S100A8/A9 (calprotectin) in hospitalized patients and determined its relationship to …
Abstract
Severe cases of coronavirus disease 2019 (COVID-19) are regularly complicated by respiratory failure. Although it has been suggested that elevated levels of blood neutrophils associate with worsening oxygenation in COVID-19, it is unknown whether neutrophils are drivers of the thrombo-inflammatory storm or simple bystanders. To better understand the potential role of neutrophils in COVID-19, we measured levels of the neutrophil activation marker S100A8/A9 (calprotectin) in hospitalized patients and determined its relationship to severity of illness and respiratory status. Patients with COVID-19 (n = 172) had markedly elevated levels of calprotectin in their blood. Calprotectin tracked with other acute phase reactants including C-reactive protein, ferritin, lactate dehydrogenase, and absolute neutrophil count, but was superior in identifying patients requiring mechanical ventilation. In longitudinal samples, calprotectin rose as oxygenation worsened. When tested on day 1 or 2 of hospitalization (n = 94 patients), calprotectin levels were significantly higher in patients who progressed to severe COVID-19 requiring mechanical ventilation (8039 ± 7031 ng/ml, n = 32) as compared to those who remained free of intubation (3365 ± 3146, P < 0.0001). In summary, serum calprotectin levels track closely with current and future COVID-19 severity, implicating neutrophils as potential perpetuators of inflammation and respiratory compromise in COVID-19.
Oxford University Press