Value of increased soluble suppressor tumorigenicity biomarker 2 (sST2) on admission as an indicator of severity in patients with COVID-19 / Valor del aumento del biomarcador supresor soluble de tumorigenicidad 2 (sST2) al ingreso como indicador de gravedad en pacientes con COVID-19

Background Soluble suppressor of tumorigenicity-2 (sST2) is a biomarker for heart failure and pulmonary injury. We hypothesize that sST2 could help predict severity of SARS-CoV-2 infections. Methods sST2 was analyzed in patients consecutively admitted for SARS-CoV-2 pneumonia. Other prognostic markers were also measured. In-hospital complications were registered, including death, ICU admission, and respiratory support requirements. Results 495 patients were studied (53% male, age: 57.6±17.6). At admission, median sST2 concentrations was 48.5ng/mL [IQR, 30.6–83.1ng/mL] and correlated with male gender, older age, comorbidities, other severity biomarkers, and respiratory support requirements. sST2 levels were higher in patients who died (n=45, 9.1%) (45.6 [28.0, 75.9]ng/mL vs. 144 [82.6, 319] ng/mL, p<0.001) and those admitted to ICU (n=46, 9.3%) (44.7 [27.5, 71.3] ng/mL vs. 125 [69.0, 262]ng/mL, p<0.001). sST2 levels>210ng/mL were a strong predictor of complicated in-hospital courses, with higher risk of death (OR, 39.3, CI95% 15.9, 103) and death/ICU (OR 38.3, CI95% 16.3–97.5) after adjusting for all other risk factors. The addition of sST2 enhanced the predictive capacity of mortality risk models. Conclusions sST2 represents a robust severity predictor in COVID-19 and could be an important tool for identifying at-risk patients who may benefit from closer follow-up and specific therapies (AU)

Antecedentes El supresor soluble de tumorigenicidad 2 (sST2) es un biomarcador de insuficiencia cardiaca y daño pulmonar. Nuestra hipótesis es que la determinación de sST2 al ingreso podría ayudar a predecir la gravedad de la infección por SARS-CoV-2. Métodos Se analizó la concentración de sST2 en pacientes ingresados por neumonía por SARS-CoV-2, junto con otros biomarcadores pronósticos conocidos. Asimismo, se registraron las complicaciones durante la estancia hospitalaria, incluidas la muerte, el ingreso en Unidad de Cuidados Intensivos (UCI) y los requerimientos de soporte respiratorio. Resultados Se estudiaron 495 pacientes (53% hombres, edad 57,6 ± 17,6). Al ingreso, la mediana de la concentración de sST2 fue 48,5 ng/mL (índice intercuartílico [IQR] 30,6-83,1 ng/mL) y correlacionó con el género masculino, una mayor edad, comorbilidades, otros biomarcadores de gravedad, así como necesidad de soporte respiratorio. Los niveles de sST2 fueron mayores en pacientes que fallecieron (n = 45, 9,1%) (45,6 [28,0, 75,9] ng/mL vs. 144 [82,6, 319] ng/mL, p < 0,001) y aquellos que requirieron ingreso en UCI (n = 46, 9,3%) (44,7 [27,5, 71,3] ng/mL vs. 125 [69,0, 262] ng/mL, p < 0,001). Así, los valores de sST2 > 210 ng/mL se han demostrado como un fuerte predictor de complicaciones, con un mayor riesgo de fallecimiento (odds ratio [OR], 39,3, intervalo de confianza [IC] 95% 15,9, 103) y fallecimiento o ingreso en UCI (OR 38,3, IC 95% 16,3-97,5), tras el ajuste por todos los demás factores de riesgo. La adición de la determinación de los niveles de sST2 mejoró la potencia predictiva de los modelos de riesgo desarrollados. Conclusiones El sST2 representa un predictor robusto de la gravedad en pacientes con COVID-19 y podría convertirse en una herramienta importante para la identificación de pacientes en riesgo que podrían beneficiarse de un mayor seguimiento y terapias específicas (AU)

Value of increased soluble suppressor tumorigenicity biomarker 2 (sST2) on admission as an indicator of severity in patients with COVID-19.

BACKGROUND: Soluble suppressor of tumorigenicity-2 (sST2) is a biomarker for heart failure and pulmonary injury. We hypothesize that sST2 could help predict severity of SARS-CoV-2 infections. METHODS: sST2 was analyzed in patients consecutively admitted for SARS-CoV-2 pneumonia. Other prognostic markers were also measured. In-hospital complications were registered, including death, ICU admission, and respiratory support requirements. RESULTS: 495 patients were studied (53% male, age: 57.6±17.6). At admission, median sST2 concentrations was 48.5ng/mL [IQR, 30.6-83.1ng/mL] and correlated with male gender, older age, comorbidities, other severity biomarkers, and respiratory support requirements. sST2 levels were higher in patients who died (n=45, 9.1%) (45.6 [28.0, 75.9]ng/mL vs. 144 [82.6, 319] ng/mL, p<0.001) and those admitted to ICU (n=46, 9.3%) (44.7 [27.5, 71.3] ng/mL vs. 125 [69.0, 262]ng/mL, p<0.001). sST2 levels>210ng/mL were a strong predictor of complicated in-hospital courses, with higher risk of death (OR, 39.3, CI95% 15.9, 103) and death/ICU (OR 38.3, CI95% 16.3-97.5) after adjusting for all other risk factors. The addition of sST2 enhanced the predictive capacity of mortality risk models. CONCLUSIONS: sST2 represents a robust severity predictor in COVID-19 and could be an important tool for identifying at-risk patients who may benefit from closer follow-up and specific therapies.

CA 15-3 prognostic biomarker in SARS-CoV-2 pneumonia.

The severity of lung involvement is the main prognostic factor in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Carbohydrate antigen 15-3 (CA 15-3), a marker of lung damage and fibrosis, could help predict the prognosis of SARS-CoV-2 pneumonia. This was a retrospective and observational study. CA 15-3 was analyzed in the blood samples of patients consecutively admitted for SARS-CoV-2 pneumonia and whose blood samples were available in the biobank. Other prognostic markers were also measured (interleukin 6 [IL6], C-reactive protein [CRP], D-dimer, troponin T, and NT-ProBNP). The occurrence of in-hospital complications was registered, including death, the need for medical intensive care, and oxygen therapy at discharge. In this study, 539 patients were recruited (54.9% men, mean age: 59.6 ± 16.4 years). At admission, the mean concentrations of CA 15-3 was 20.5 ± 15.8 U/mL, and the concentration was correlated with male sex, older age, and other severity markers of coronavirus disease of 2019 (COVID-19) (IL6, CRP, D-dimer, troponine T, and NT-ProBNP). CA 15-3 levels were higher in patients who died (n = 56, 10.4%) (35.33 ± 30.45 vs. 18.8 ± 12.11, p < 0.001), who required intensive medical support (n = 78, 14.4%; 31.17 ± 27.83 vs. 18.68 ± 11.83; p < 0.001), and who were discharged with supplemental oxygen (n = 64, 13.3%; 22.65 ± 14.41 vs. 18.2 ± 11.7; p = 0.011). Elevated CA 15-3 levels (above 34.5 U/mL) were a strong predictor of a complicated in-hospital course, in terms of a higher risk of death (adjusted odds ratio [OR] 3.74, 95% confidence interval [CI]: 1.22-11.9, p = 0.022) and need for intensive care (adjusted OR 4.56, 95% CI: 1.37-15.8) after adjusting for all other risk factors. The degree of lung damage and fibrosis evaluated in terms of CA 15-3 concentrations may allow early identification of the increased risk of complications in patients with SARS-CoV-2 pneumonia.