Serum neopterin levels in relation to mild and severe COVID-19
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RESEARCH ARTICLE
Open Access
Serum neopterin levels in relation to mild and severe COVID-19 Josefina Robertson1,2* , Johanna M. Gostner3, Staffan Nilsson4, Lars-Magnus Andersson1,2, Dietmar Fuchs5 and Magnus Gisslen1,2
Abstract Background: The COVID-19 pandemic, caused by the coronavirus SARS-CoV-2, is rapidly spreading worldwide. There is limited information about prognostic markers that could help clinicians to identify COVID-19 patients with a poor prognosis. Serum levels of the immune activation marker neopterin has shown to be of prognostic value in patients with SARS. The aim of this study was to investigate whether serum neopterin is associated with the severity of COVID-19. Methods: We included 34 patients with confirmed COVID-19 between March 3 and March 30, 2020. Fifteen patients had mild disease and did not require hospitalization, whereas 19 patients developed severe COVID-19 requiring intensive care. Concentrations of serum neopterin, tryptophan, and kynurenine were measured at and repeatedly after inclusion. Results: We found a more than two-fold higher mean concentration of neopterin in severely ill patients (mean value 42.0 nmol/L (SD 18.2)) compared to patients with mild symptoms (16.9 nmol/L (SD 11.0)). All of the severe cases had elevated neopterin concentrations (> 9.1 nmol/L) at the initial sampling with values ranging from 17.2 to 86.7 nmol/L. In comparison, 10 of 15 patients with mild disease had neopterin levels above 9.1 nmol/L, with concentrations in the range from 4.9 to 31.6 nmol/L. Neopterin levels gradually decreased during the course of COVID-19, but severe cases maintained elevated levels for a longer period. Moreover, lower levels of tryptophan and higher levels of kynurenine, indicating an increased tryptophan catabolism, were seen in the group with severe cases. Conclusions: In conclusion, we found that serum neopterin levels are associated with the severity of COVID-19. Our findings suggest that neopterin could be used as a prognostic marker, but further studies are needed to elucidate how it can be used in the clinic. Keywords: COVID-19, Prognostic markers, Neopterin, Tryptophan, Kynurenine
Introduction The COVID-19 pandemic, caused by the coronavirus SARS-CoV-2, is rapidly spreading worldwide [1]. Most patients have mild symptoms from the upper respiratory tract, whereas a minor but not negligible proportion suffers from a severe form of the disease, which in some cases require intensive care [2]. There is limited * Correspondence: [email protected] 1 Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 2 Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden Full list of author information is available at the end of the article
information about prognostic markers that could help clinicians to identify COVID-19 patients with a poor prognosis. During the outbreak of the severe acute respiratory syndrome (SARS) in 2002–2003, caused
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