Predictive value of Hepcidin level in COVID-19 intensive care unit patients

ABSTRACT

Coronavirus disease 2019 (COVID-19) caused by the recently uncovered human coronavirus SARS-CoV-2 [1] presents a clinical spectrum that ranges from an asymptomatic condition to critical illness [2]. Patients with critical illness present respiratory failure, septic shock and/ or multi-organ failure induced by the so-defined cytokines storm [3]. Hepcidin modulates cellular iron export to plasma and extracellular fluid through ferroportin, which acts as hepcidin receptor and cellular iron exporter in vertebrates. Hepcidin is not routinely measured in COVID-19 patients, but some preliminary studies showed that high levels of hepcidin are associated with the severity of disease [4] as well as low levels of serum iron are correlated with the severity and mortality of disease and severe hypoxemia in intensive care unit (ICU) patients [5]. The aim of this study was to analyze retrospectively the levels of hepcidin in a group of COVID-19 patients admitted to the intensive care unit (ICU) of the Policlinico Tor Vergata of Rome, Italy. Thirty-eight patients from November 2020 to May 2021 because of pneumonia caused by SARS-CoV-2 were enrolled in the study. Based on the clinical outcome, the patients were assigned to two groups survivors and non-survivors. A series of laboratory parameters were monitored during the stay of the patients in the ICU and their levels correlated to the clinical outcome. The Hepcidin was determined with Intrinsic Hepcidin IDxTM ELISA kit (Intrinsic Lifesciences, San Diego, CA, USA) that is a competitive immunoenzymatic assay based on a monoclonal antibody (mAb) with high affinity to the Nterminus of hepcidin-25. Of the parameters measured, significant statistical differences in the level of hepcidin, IL-6, LDH, leucocyte count, LNR, NLR, neutrophils level, CRP, and TNF-alpha were observed between the survivors and non-survivors groups. Specifically, a higher level of hepcidin, IL-6, LDH, leucocyte count, LNR, NLR, neutrophils, CRP and TNF-alpha were measured in the non-survivor group compared to the survivor group. In conclusion, Hepcidin can be prognostic of the clinical outcome, moreover, it could be used together with other markers in a predictive algorithm of disease severity.