Abstract
Background: Thromboinflammation may influence disease outcome in COVID-19. We aimed to evaluate complement and endothelial cell activation in patients with confirmed COVID-19 compared to controls with clinically suspected but excluded SARS-CoV-2 infection.
Methods: In a prospective, observational, single-center study, patients presenting with clinically suspected COVID-19 were recruited in the emergency department. Blood samples on presentation were obtained for analysis of C5a, sC5b-9, E-selectin, Galectin-3, ICAM-1 and VCAM-1.
Results: 153 cases and 166 controls (suffering mainly from non-SARS-CoV-2 respiratory viral infections, non-infectious inflammatory conditions and bacterial pneumonia) were included. Hospital admission occurred in 62% and 45% of cases and controls, respectively. C5a and VCAM-1 concentrations were significantly elevated and E-selectin concentrations decreased in COVID-19 out- and inpatients compared to the respective controls. However, relative differences in outpatients vs. inpatients in most biomarkers were comparable between cases and controls. Elevated concentrations of C5a, Galectin-3, ICAM-1 and VCAM-1 on presentation were associated with the composite outcome of ICU- admission or 30-day mortality in COVID-19 and controls, yet more pronounced in COVID-19. C5a and sC5b-9 concentrations were significantly higher in COVID-19 males vs. females, which was not observed in the control group.
Conclusions: Our data indicate an activation of the complement cascade and endothelium in COVID-19 beyond a nonspecific inflammatory trigger as observed in controls (i.e., “over”-activation).
Keywords: COVID-19; E-Selectin; ICAM-1; SARS-CoV-2; VCAM-1; complement system; endothelial cells; galectin-3.
【저자키워드】 COVID-19, SARS-CoV-2, complement system, E-selectin, ICAM-1, endothelial cells, VCAM-1, galectin-3., 【초록키워드】 Biomarker, Pneumonia, SARS-COV-2 infection, complement, outcome, ICU, C5a, Endothelium, SC5b-9, male, Patient, Control, galectin-3, disease, Admission, respiratory viral infections, Bacterial, 30-Day mortality, Endothelial cell, Outpatient, Concentration, Analysis, Inflammatory, Inpatient, endothelial, Activation, control group, blood sample, single-center study, cascade, non-infectious, inflammatory condition, females, controls, evaluate, occurred, significantly, recruited, elevated, clinically suspected, significantly higher, comparable, excluded, presenting, nonspecific, 【제목키워드】 prospective cohort study, Control, Endothelial cell, COVID-19 patient, Activation,