Increasing plasma calprotectin (S100A8/A9) is associated with 12-month mortality and unfavourable functional outcome in critically ill COVID-19 patients
Didriksson, Ingrid LU
; Lengquist, Maria
LU
; Spångfors, Martin
LU
; Leffler, Märta
LU
; Sievert, Theodor
LU
; Lilja, Gisela
LU
; Frigyesi, Attila
LU
; Friberg, Hans
LU
and Schiopu, Alexandru
LU
(2024)
In Journal of Intensive Care
12(1).
- Abstract
BACKGROUND: Calprotectin (S100A8/A9) is a pro-inflammatory mediator primarily released from neutrophils. Previous studies have revealed associations between plasma calprotectin, disease severity and in-hospital mortality in unselected COVID-19 patients.
OBJECTIVE: We aimed to assess whether plasma calprotectin dynamics during the first week of intensive care are associated with mortality and functional outcome in critically ill COVID-19 patients.
METHODS: This prospective study included 498 COVID-19 patients admitted to six intensive care units (ICUs) in Sweden between May 2020 and May 2021. Blood samples were collected on ICU admission and on day 7. The primary outcome was 12-month mortality. Secondary outcomes were... (More)
BACKGROUND: Calprotectin (S100A8/A9) is a pro-inflammatory mediator primarily released from neutrophils. Previous studies have revealed associations between plasma calprotectin, disease severity and in-hospital mortality in unselected COVID-19 patients.
OBJECTIVE: We aimed to assess whether plasma calprotectin dynamics during the first week of intensive care are associated with mortality and functional outcome in critically ill COVID-19 patients.
METHODS: This prospective study included 498 COVID-19 patients admitted to six intensive care units (ICUs) in Sweden between May 2020 and May 2021. Blood samples were collected on ICU admission and on day 7. The primary outcome was 12-month mortality. Secondary outcomes were functional outcome of survivors at 3 and 12 months, and the need for invasive mechanical ventilation (IMV) or continuous renal replacement therapy (CRRT) during the ICU stay. Functional outcome was assessed by the Glasgow Outcome Scale Extended (GOSE, range 1-8, with < 5 representing an unfavourable outcome). Associations between plasma calprotectin and outcomes were examined in binary logistic regression analyses adjusted for age, sex, BMI, hypertension, smoking, and creatinine.
RESULTS: High plasma calprotectin on admission and day 7 was independently associated with increased 12-month mortality. Increasing calprotectin from admission to day 7 was independently associated with higher mortality at 12 months [OR 2.10 (95% CI 1.18-3.74), p = 0.012], unfavourable functional outcome at 3 months [OR 2.53 (95% CI 1.07-6.10), p = 0.036], and the use of IMV [OR 2.23 (95% CI 1.10-4.53), p = 0.027)] and CRRT [OR 2.07 (95% CI 1.07-4.00), p = 0.031)]. A receiver operator characteristic (ROC) model including day 7 calprotectin and age was a good predictor of 12-month mortality [AUC 0.79 (95% CI 0.74-0.84), p < 0.001]. Day 7 calprotectin alone predicted an unfavourable functional outcome at 3 months [AUC 0.67 (95% CI 0.58-0.76), p < 0.001].
CONCLUSION: In critically ill COVID-19 patients, increasing calprotectin levels after admission to the ICU are associated with 12-month mortality and unfavourable functional outcome in survivors. Monitoring plasma calprotectin dynamics in the ICU may be considered to evaluate prognosis in critical COVID-19.
STUDY REGISTRATION: ClinicalTrials.gov Identifier: NCT04974775, registered April 28, 2020.
(Less)
- author
- Didriksson, Ingrid
LU
; Lengquist, Maria
LU
; Spångfors, Martin
LU
; Leffler, Märta
LU
; Sievert, Theodor
LU
; Lilja, Gisela
LU
; Frigyesi, Attila
LU
; Friberg, Hans
LU
and Schiopu, Alexandru
LU
- organization
-
- Anaesthesiology and Intensive Care Medicine (research group)
- SWECRIT (research group)
- Center for cardiac arrest (research group)
- Mitochondrial Medicine (research group)
- Intensive Care Epidemiology (research group)
- Cardiac Inflammation Research Group (research group)
- EXODIAB: Excellence of Diabetes Research in Sweden
- publishing date
- 2024-07-09
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Journal of Intensive Care
- volume
- 12
- issue
- 1
- article number
- 26
- publisher
- BioMed Central (BMC)
- external identifiers
-
- pmid:38982551
- scopus:85197790776
- ISSN
- 2052-0492
- DOI
- 10.1186/s40560-024-00740-4
- language
- English
- LU publication?
- yes
- additional info
- © 2024. The Author(s).
- id
- 05dfed61-4d0c-46f7-abdb-1a53d08f7fbd
- date added to LUP
- 2024-07-13 09:48:26
- date last changed
- 2024-07-15 11:09:46
@article{05dfed61-4d0c-46f7-abdb-1a53d08f7fbd,
abstract = {{<p>BACKGROUND: Calprotectin (S100A8/A9) is a pro-inflammatory mediator primarily released from neutrophils. Previous studies have revealed associations between plasma calprotectin, disease severity and in-hospital mortality in unselected COVID-19 patients.</p><p>OBJECTIVE: We aimed to assess whether plasma calprotectin dynamics during the first week of intensive care are associated with mortality and functional outcome in critically ill COVID-19 patients.</p><p>METHODS: This prospective study included 498 COVID-19 patients admitted to six intensive care units (ICUs) in Sweden between May 2020 and May 2021. Blood samples were collected on ICU admission and on day 7. The primary outcome was 12-month mortality. Secondary outcomes were functional outcome of survivors at 3 and 12 months, and the need for invasive mechanical ventilation (IMV) or continuous renal replacement therapy (CRRT) during the ICU stay. Functional outcome was assessed by the Glasgow Outcome Scale Extended (GOSE, range 1-8, with < 5 representing an unfavourable outcome). Associations between plasma calprotectin and outcomes were examined in binary logistic regression analyses adjusted for age, sex, BMI, hypertension, smoking, and creatinine.</p><p>RESULTS: High plasma calprotectin on admission and day 7 was independently associated with increased 12-month mortality. Increasing calprotectin from admission to day 7 was independently associated with higher mortality at 12 months [OR 2.10 (95% CI 1.18-3.74), p = 0.012], unfavourable functional outcome at 3 months [OR 2.53 (95% CI 1.07-6.10), p = 0.036], and the use of IMV [OR 2.23 (95% CI 1.10-4.53), p = 0.027)] and CRRT [OR 2.07 (95% CI 1.07-4.00), p = 0.031)]. A receiver operator characteristic (ROC) model including day 7 calprotectin and age was a good predictor of 12-month mortality [AUC 0.79 (95% CI 0.74-0.84), p < 0.001]. Day 7 calprotectin alone predicted an unfavourable functional outcome at 3 months [AUC 0.67 (95% CI 0.58-0.76), p < 0.001].</p><p>CONCLUSION: In critically ill COVID-19 patients, increasing calprotectin levels after admission to the ICU are associated with 12-month mortality and unfavourable functional outcome in survivors. Monitoring plasma calprotectin dynamics in the ICU may be considered to evaluate prognosis in critical COVID-19.</p><p>STUDY REGISTRATION: ClinicalTrials.gov Identifier: NCT04974775, registered April 28, 2020.</p>}},
author = {{Didriksson, Ingrid and Lengquist, Maria and Spångfors, Martin and Leffler, Märta and Sievert, Theodor and Lilja, Gisela and Frigyesi, Attila and Friberg, Hans and Schiopu, Alexandru}},
issn = {{2052-0492}},
language = {{eng}},
month = {{07}},
number = {{1}},
publisher = {{BioMed Central (BMC)}},
series = {{Journal of Intensive Care}},
title = {{Increasing plasma calprotectin (S100A8/A9) is associated with 12-month mortality and unfavourable functional outcome in critically ill COVID-19 patients}},
url = {{http://dx.doi.org/10.1186/s40560-024-00740-4}},
doi = {{10.1186/s40560-024-00740-4}},
volume = {{12}},
year = {{2024}},
}