Gentian Diagnostics ASA

Environmental & Social Information • Nov 1, 2021

Background:

COVID-19 is associated with a wide range of manifestations. Especially in the emergency department (ED) it is vital to identify patients with a high risk for development of multi-organ failure. Calprotectin is a novel biomarker found in the intracellular compartment of cells of the granulomonocytic lineage We recently identified serum calprotectin levels to be an excellent predictor of multi-organ failure, need for intensive care unit (ICU) treatment and death² .

1 .

Patients and Methods:

This analysis of an ongoing prospective controlled trial (CASCADE) was performed in the ED of the Charité – Universitätsmedizin Berlin Campus Benjamin Franklin from the beginning of February 2021. We have so far investigated a cohort of 70 patients, 43 with suspected infections and 27 with suspected non-infectious illness with 10 cases of COVID-19 proven by PCR.

ICU = Intensive Care Unit; n = Number of participants; PCR = Polymerase Chain Reaction

Results:

A total of 4 out of 10 COVID-19 patients were admitted to ICU and 1 patient died. Age median was 67 years (standard deviation 17.6 years) with 54% being male patients, in COVID-19 group of patients the median age was 48 (standard deviation 14.8 years) with 80% male patients. Calprotectin was measured in heparin plasma by PETIA method from Gentian AS, Norway. It was significantly higher in ventilated than in non-ventilated COVID-19 patients. Calprotectin was able to predict ICUadmission with an AUROC of 1.0 and performed better than procalcitonin.

Plasma calprotectin as a novel biomarker in COVID-19 in emergency medicine: Preliminary results of the ongoing CASCADE trial

Iris R. Betz 1 , Johannes Dickescheid 1 , Noa Galtung 1 , Aleksandra Havelka 3 , Kai Kappert 2 , Rajan Somasundaram¹ and Wolfgang Bauer 1 1. Department of Emergency Medicine Campus Benjamin Franklin; 2. Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité Universitätsmedizin, Berlin, Germany; 3. Gentian AS, Moss, Norway

	N	Overall	SARS-CoV2	Non SARS-CoV2	P-value
Number of patients [n (%)]	70	70 (100)	10 (14,3)	60 (85,7)
Demographics
Age [Mean (IQR)]	70	67 (51-78)	48 (41-60)	70 (53-80)	0,012
Sex female [n (%)]	70	31 (44,3)	2 (20)	29 (48,3)	0,097
Vital signs
BP syst. (mmHg) [Mean (IQR)]	70	135 (116-140)	133 (116-140)	137 (116-154)	0,557
Respiration rate (/min.) [Mean (IQR)]	70	16 (14-22)	18 (15-25)	16 (14-21)	0,385
Laboratory data
Creatinine (mg/dl) [Mean (IQR)]	70	0,94 (0,76-1,29)	0,93 (0,78-1)	0,94 (0,75-1,31)	0,808
Bilirubin (mg/dl) [Mean (IQR)]	55	0,59 (0,32-0,94)	0,6 (0,37-0,74)	0,58 (0,32-0,95)	0,904
Procalcitonin [µg/l] [Mean (IQR)]	49	0,17 (0,08-0,62)	0,1 (0,7-0,31)	0,18 (0,08-0,68)	0,275
CRP [mg/l] [Mean (IQR)]	64	27,2 (1,9-114,5)	70,3 (21,3-152,8)	15,9 (1,4-106,9)	0,144
WBC (/nl) [Mean (IQR)]	70	7,8 (4,5-12,7)	7,3 (6,2-8,1)	8,3 (3,5-12,9)	0,397
Platelets (/nl) [Mean (IQR)]	70	226 (174-285)	163 (152-211)	235 (192-290)	0,006
ICU admission [n (%)]	69	11 (15,7)	4 (40)	7 (11,7)	0,026
Mechanical ventilation [n (%)]	69	8 (11,4)	4 (40)	4 (6,7)	0,003
Comorbidities [n (%)]	70	58 (82,9)	7 (70)	51 (85)	0,247
90-days mortality [n (%)]	70	6 (8,6)	1 (10)	5 (8,3)	0,863

Tab. 1: Baseline characteristics of the recruited patients until May 2021. IQR = interquartile range; BP syst. = systolic blood pressure

²Bauer, W. et al. Outcome prediction by serum calprotectin in patients with COVID-19 in the emergency department. J Infect 82, 84–123 (2021). ³Rendeiro, A. F. et al. The spatial landscape of lung pathology during COVID-19 progression. Nature 593, 564–569 (2021).

in COVID patients. Calprotectin is outperforming Procalcitonin in the preliminary cohort in predicting admission to the ICU. n = 10

Conclusion and perspective:

Calprotectin is an easy to assess blood biomarker that is able to predict severe courses of disease in COVID-19 patients presented at the ED. The reason for this might be that especially the lung injury that is caused by macrophages and granulocytes is associated with poor outcome 3 . Macrophages and granulocytes release calprotectin which is highly involved in the pro-inflammatory response generated in COVID-19.

Fig.2: Calprotectin levels in COVID-19 (ventilated and non-ventilated) and infectious, non-COVID-19 ICU patients. A ventilated = 4, not ventilated = 6; B infectious non-COVID n = 60, COVID = 10; ** = p < 0.01, ns = non significant

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