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Research
Serum surfactant protein A and D may be novel biomarkers of COVID-19 pneumonia severity
KOJI KURONUMA
Sapporo Medical University School of Medicine
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: COVID-19 is currently undergoing a pandemic worldwide, including in Japan, and many lives have been lost. So, there is an urgent need to develop new biomarkers for estimating progression or prognosis of COVID-19 patient. Lung-specific serum biomarkers, SP-A, SP-D and KL-6 have been used clinically for diagnosis of interstitial lung disease (ILDs), but their use in COVID-19 has not been investigated. To determine whether serum levels of SP-A, SP-D and KL-6 correlate with the severity of COVID-19 as indicated by clinical symptoms and radiological findings.
Methods: In a cohort of 46 consecutive COVID-19 patients, laboratory data including serum SP-A, SP-D and KL-6 concentrations of 82 blood samples were analyzed and compared between severe and non-severe cases. In addition, the disease severity as indicated by these markers and chest HRCT images were compared.
Results: Serum SP-A was significantly elevated from the early stage of pneumonia. In addition, serum SP-A and SP-D were significantly higher in severe than in non-severe cases. KL-6 was also significantly higher in severe-cases, but its mean was below the cut-off level for ILDs. AUC and their cut-off levels to detect severe cases in patients with COVID-19 infection were 0.796 for 94.9 ng/ml of SP-A, 0.827 for 116 ng/ml of SP-D and 0.640 for 275 U/ml of KL-6. HRCT image severity scores showed moderate correlations with SP-A (ρ=0.5996, p<0.001), SP-D (ρ=0.6268, p<0.001), and weak with KL-6 (ρ=0.3489, p<0.001). In the typical course of patients whose pneumonia worsened from non-severe to severe, the serum SP-A and SP-D levels increased nearly in parallel with clinical findings and HRCT images.
Conclusions: Lung-specific serum SP-A and SP-D level increased with symptom and radiological findings. These elevations can be detected from relatively early pneumonia. These results indicated that these might become a novel biomarker in COVID-19 pneumonia.
Keywords
SARS-CoV-2; COVID-19; Surfactant protein A; Surfactant protein D
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Nikita
commented on 02 June, 2020
Dear Author Can you Highlight the Outcomes of Patients with severe disease and elevated levels of SP-D? Also, Can you disclose the Metabolic status /Diabetes/Obesity in such (i.e elevated SP-D ) patients if you have gathered any such data?
Hideyuki Takano
commented on 30 June, 2020
Your data is very important for my hypothesis. Your data may be explained by buttle of surfactant and SARS-CoV-2. Pulmonary surfactant itself must be a strong defender against SARS-CoV-2 https://www.sciencedirect.com/science/article/pii/S0306987720310732
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This is a preprint. It has not completed peer review.
Research
Serum surfactant protein A and D may be novel biomarkers of COVID-19 pneumonia severity
KOJI KURONUMA
Sapporo Medical University School of Medicine
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 21 May, 2020
Community comments: 2
Metrics
Comments: 2
PDF Downloads: ...
HTML Views: ...
Subject Areas
Pulmonology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: COVID-19 is currently undergoing a pandemic worldwide, including in Japan, and many lives have been lost. So, there is an urgent need to develop new biomarkers for estimating progression or prognosis of COVID-19 patient. Lung-specific serum biomarkers, SP-A, SP-D and KL-6 have been used clinically for diagnosis of interstitial lung disease (ILDs), but their use in COVID-19 has not been investigated. To determine whether serum levels of SP-A, SP-D and KL-6 correlate with the severity of COVID-19 as indicated by clinical symptoms and radiological findings.
Methods: In a cohort of 46 consecutive COVID-19 patients, laboratory data including serum SP-A, SP-D and KL-6 concentrations of 82 blood samples were analyzed and compared between severe and non-severe cases. In addition, the disease severity as indicated by these markers and chest HRCT images were compared.
Results: Serum SP-A was significantly elevated from the early stage of pneumonia. In addition, serum SP-A and SP-D were significantly higher in severe than in non-severe cases. KL-6 was also significantly higher in severe-cases, but its mean was below the cut-off level for ILDs. AUC and their cut-off levels to detect severe cases in patients with COVID-19 infection were 0.796 for 94.9 ng/ml of SP-A, 0.827 for 116 ng/ml of SP-D and 0.640 for 275 U/ml of KL-6. HRCT image severity scores showed moderate correlations with SP-A (ρ=0.5996, p<0.001), SP-D (ρ=0.6268, p<0.001), and weak with KL-6 (ρ=0.3489, p<0.001). In the typical course of patients whose pneumonia worsened from non-severe to severe, the serum SP-A and SP-D levels increased nearly in parallel with clinical findings and HRCT images.
Conclusions: Lung-specific serum SP-A and SP-D level increased with symptom and radiological findings. These elevations can be detected from relatively early pneumonia. These results indicated that these might become a novel biomarker in COVID-19 pneumonia.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Nikita
commented on 02 June, 2020
Dear Author Can you Highlight the Outcomes of Patients with severe disease and elevated levels of SP-D? Also, Can you disclose the Metabolic status /Diabetes/Obesity in such (i.e elevated SP-D ) patients if you have gathered any such data?
Hideyuki Takano
commented on 30 June, 2020
Your data is very important for my hypothesis. Your data may be explained by buttle of surfactant and SARS-CoV-2. Pulmonary surfactant itself must be a strong defender against SARS-CoV-2 https://www.sciencedirect.com/science/article/pii/S0306987720310732