TY - JOUR
T1 - The Predictive Role of C-Reactive Protein, Leukocyte Cell Count, and Soluble Urokinase Plasminogen Activator Receptor for Pulmonary Sequelae in Hospitalized COVID-19 Survivors
T2 - A Prospective Single-Center Cohort Study
AU - Altintas, Izzet
AU - Kallemose, Thomas
AU - Lindstrøm, Mette Bendtz
AU - Parvaiz, Imran
AU - Rokkedal, Iben
AU - Rasmussen, Lene Juel
AU - Iversen, Katrine Kjær
AU - Eugen-Olsen, Jesper
AU - Iversen, Kasper Karmark
AU - Hansen, Ejvind Frausing
AU - Ulrik, Charlotte Suppli
AU - Nehlin, Jan Olof
AU - Andersen, Ove
N1 - Publisher Copyright:
© 2025 by the authors.
PY - 2025
Y1 - 2025
N2 - Highlights: What is already known on this topic? There is an urgent clinical need for biomarkers to predict pulmonary deterioration among acutely admitted patients with COVID-19. Patients with COVID-19 present with a wide range of clinical outcomes, from mild illness to respiratory failure. Identifying patients who are at risk of deterioration early on can guide clinical management, resource allocation, and targeted interventions. What does this study add? This study shows that the most commonly affected pulmonary function parameter during follow-up was DLCO impairment. Among the biomarkers studied, soluble urokinase Plasminogen Activator Receptor (suPAR) at admittance demonstrated the strongest correlation with DLCO impairment, and a low suPAR cut-off value showed the highest negative predictive value (NPV) for DLCO impairment. How might this study affect research, practice, or policy? This study could assist physicians in reducing the number of patients requiring follow-up at pulmonary outpatient clinics, particularly due to the high negative predictive value (NPV) of the biomarkers in forecasting DLCO impairment. This could potentially be of benefit for individual patients and, at the same time, alleviate the pressure on the healthcare system. Background: Pulmonary function impairment significantly affects quality of life, work ability, and healthcare utilization. Among patients with COVID-19, respiratory symptoms vary in severity. This study aimed to assess whether biomarkers related to respiratory function and inflammation at emergency department (ED) admittance can predict long-term pulmonary function impairment in COVID-19 survivors. Methods: This prospective single-center study recruited patients 4–5 months post-COVID-19 infection using consecutive sampling. All attendees at the respiratory outpatient clinic were invited to participate. Pulmonary function tests, including diffusing capacity of the lungs for carbon monoxide (DLCO), total lung capacity (TLC), forced expiratory volume in the first second (FEV1), and forced vital capacity (FVC), were performed, with DLCO < 80% as the key indicator of impairment. Baseline biomarkers—C-Reactive Protein (CRP), leukocyte counts, and soluble urokinase Plasminogen Activator Receptor (suPAR)—were correlated with post-discharge DLCO values. Results: This study enrolled 110 patients with COVID-19; 58.2% were female, the median age was 61.5, and the average BMI was 27.2. Smoking history showed that 53.7% were never smokers, 43.5% were former smokers, and 2.8% were current smokers. A diffusion deficit (DLCO < 80%) was present in 48.6% of patients. Leukocyte counts and suPAR had the highest sensitivity (>0.80) for predicting DLCO impairment but showed low specificity and a positive predictive value (PPV) of around 0.50. However, combining all biomarkers improved prediction accuracy, with a negative predictive value (NPV) of 0.93. Conclusions: The chosen inflammatory biomarkers by themselves had a limited ability to predict long-term pulmonary function impairment in COVID-19 survivors. However, when combined, they demonstrated a high negative predictive value (NPV) for identifying DLCO impairment. This strategy could help clinicians better tailor follow-up care for patients with COVID-19.
AB - Highlights: What is already known on this topic? There is an urgent clinical need for biomarkers to predict pulmonary deterioration among acutely admitted patients with COVID-19. Patients with COVID-19 present with a wide range of clinical outcomes, from mild illness to respiratory failure. Identifying patients who are at risk of deterioration early on can guide clinical management, resource allocation, and targeted interventions. What does this study add? This study shows that the most commonly affected pulmonary function parameter during follow-up was DLCO impairment. Among the biomarkers studied, soluble urokinase Plasminogen Activator Receptor (suPAR) at admittance demonstrated the strongest correlation with DLCO impairment, and a low suPAR cut-off value showed the highest negative predictive value (NPV) for DLCO impairment. How might this study affect research, practice, or policy? This study could assist physicians in reducing the number of patients requiring follow-up at pulmonary outpatient clinics, particularly due to the high negative predictive value (NPV) of the biomarkers in forecasting DLCO impairment. This could potentially be of benefit for individual patients and, at the same time, alleviate the pressure on the healthcare system. Background: Pulmonary function impairment significantly affects quality of life, work ability, and healthcare utilization. Among patients with COVID-19, respiratory symptoms vary in severity. This study aimed to assess whether biomarkers related to respiratory function and inflammation at emergency department (ED) admittance can predict long-term pulmonary function impairment in COVID-19 survivors. Methods: This prospective single-center study recruited patients 4–5 months post-COVID-19 infection using consecutive sampling. All attendees at the respiratory outpatient clinic were invited to participate. Pulmonary function tests, including diffusing capacity of the lungs for carbon monoxide (DLCO), total lung capacity (TLC), forced expiratory volume in the first second (FEV1), and forced vital capacity (FVC), were performed, with DLCO < 80% as the key indicator of impairment. Baseline biomarkers—C-Reactive Protein (CRP), leukocyte counts, and soluble urokinase Plasminogen Activator Receptor (suPAR)—were correlated with post-discharge DLCO values. Results: This study enrolled 110 patients with COVID-19; 58.2% were female, the median age was 61.5, and the average BMI was 27.2. Smoking history showed that 53.7% were never smokers, 43.5% were former smokers, and 2.8% were current smokers. A diffusion deficit (DLCO < 80%) was present in 48.6% of patients. Leukocyte counts and suPAR had the highest sensitivity (>0.80) for predicting DLCO impairment but showed low specificity and a positive predictive value (PPV) of around 0.50. However, combining all biomarkers improved prediction accuracy, with a negative predictive value (NPV) of 0.93. Conclusions: The chosen inflammatory biomarkers by themselves had a limited ability to predict long-term pulmonary function impairment in COVID-19 survivors. However, when combined, they demonstrated a high negative predictive value (NPV) for identifying DLCO impairment. This strategy could help clinicians better tailor follow-up care for patients with COVID-19.
KW - COVID-19
KW - CRP
KW - DL
KW - leukocyte cell count
KW - prediction
KW - pulmonary function impairment
KW - SARS-CoV-2
KW - suPAR
U2 - 10.3390/jcm14051717
DO - 10.3390/jcm14051717
M3 - Journal article
C2 - 40095788
AN - SCOPUS:86000512175
SN - 2077-0383
VL - 14
JO - Journal of Clinical Medicine
JF - Journal of Clinical Medicine
IS - 5
M1 - 1717
ER -