Early Measurement of Blood sST2 Is a Good Predictor of Death and Poor Outcomes in Patients Admitted for COVID-19 Infection

  1. Marta Sánchez-Marteles
  2. Jorge Rubio-Gracia
  3. Natacha Peña-Fresneda
  4. Vanesa Garcés-Horna
  5. Borja Gracia-Tello
  6. Luis Martínez-Lostao
  7. Silvia Crespo-Aznárez
  8. Juan Ignacio Pérez-Calvo
  9. Ignacio Giménez-López

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Abstract

Although several biomarkers have shown correlation to prognosis in COVID-19 patients, their clinical value is limited because of lack of specificity, suboptimal sensibility or poor dynamic behavior. We hypothesized that circulating soluble ST2 (sST2) could be associated to a worse outcome in COVID-19. In total, 152 patients admitted for confirmed COVID-19 were included in a prospective non-interventional, observational study. Blood samples were drawn at admission, 48–72 h later and at discharge. sST2 concentrations and routine blood laboratory were analyzed. Primary endpoints were admission at intensive care unit (ICU) and mortality. Median age was 57.5 years [Standard Deviation (SD: 12.8)], 60.4% males. 10% of patients (n = 15) were derived to ICU and/or died during admission. Median (IQR) sST2 serum concentration (ng/mL) rose to 53.1 (30.9) at admission, peaked at 48–72 h (79.5(64)) and returned to admission levels at discharge (44.9[36.7]). A concentration of sST2 above 58.9 ng/mL was identified patients progressing to ICU admission or death. Results remained significant after multivariable analysis. The area under the receiver operating characteristics curve (AUC) of sST2 for endpoints was 0.776 (p = 0.001). In patients admitted for COVID-19 infection, early measurement of sST2 was able to identify patients at risk of severe complications or death.

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  1. Version published to 10.3390/jcm10163534
  2. ScreenIT

    SciScore for 10.1101/2020.12.29.20248989: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: Inclusion criteria: 1) Age ≥ 18 years. 2) Informed consent granted.
    IRB: The study complied with the fundamental guidelines of the Helsinki declaration guidelines and was evaluated and approved by Aragón’s Committee on Research Ethics (CEICA, Ref.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analysis was carried out with Statistical Package for the Social Sciences (SPSS) version 24.0 for Windows (IBM).
    Statistical Package for the Social Sciences
    suggested: (SPSS, RRID:SCR_002865)
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has some limitations. It has been conducted in a single center and on a small sample size, this latter driven by the urgency to advance our knowledge on the disease. Nonetheless, clinical characteristics in our cohort were concordant with published data from other studies around the world and in our country1,2. Due to resource limitations imposed by the demanding sanitary situation, access to imaging and functional tests was difficult to standardize for even a representative fraction of study patients and thus their clinical value could not be compared directly to that of sST2. Clinical data for the study was collected under conditions of real practice. Obviously, this may imply unforeseen bias have been introduced, but multivariable analysis diminished this risk. And in the other hand, in a such heterogenous syndrome and with pandemic assistance, this setting could be more a strength than a limitation. Identification of sST2 as an early predictor of worst prognosis in COVID-19 patients has important clinical implications. sST-2 is a readily available biomarker, which can be consistently determined in blood samples. Accumulating evidence supports sST2 levels elevate early in SARS-CoV2 infection and that such changes represent an independent risk factor for worse outcome, outpowering other biomarkers that so far have been guiding clinical and therapeutical handling. Another consistent report is the persistence of elevated sST2 after apparent clinical resolution. Give...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.12.29.20248989 on medRxiv