An analysis of novel endothelial biomarkers to ascertain their role as prognostic indicators in severe COVID-19 illness

Background & objectives: COVID-19 is a complex disease that affects multiple systems and causes inflammation due to the SARS-CoV-2 virus's attraction to ACE-2 receptors. The severity of the disease ranges from mild upper respiratory tract infections to multi-organ failure and disseminated intravascular coagulation. Critical clinical features, such as respiratory failure, myocarditis, acute kidney injury, and a hypercoagulable state, are common in severe COVID-19 illness. Identifying patients at higher risk of rapid disease progression leading to severe complications and death is crucial. Available biomarkers lack specificity and accuracy in identifying the severity of COVID-19 infections. Therefore, there is a need to identify specific endothelial biomarkers that can predict early organ damage, facilitate effective management of patients, and categorise multisystem involvement during COVID-19 infection. Methods: The participants constituted laboratory-confirmed COVID-19-positive patients with influenzalike illness (ILI) features under home isolation or moderate to severe acute respiratory infection (SARI) manifestations requiring admission. The chosen markers were analysed using the Human Luminex multiplex bead-based assay system. Results: Our study revealed that certain markers, such as intercellular adhesion molecule (ICAM) and Galectin-3 were elevated in all COVID-19-positive patients, while others, like vascular cell adhesion molecule (VCAM), Angiopoietin-2, Thrombomodulin, and tumour necrosis factor receptor 1 (TNFR1) were specifically elevated in patients requiring admission. Such findings indicated the potential of some biomarkers in disease prognostication. Interpretation & conclusions: Effective management of COVID-19 requires proper risk stratification. The findings of our investigation underscore the necessity for additional research to confirm the clinical utility and importance of these biomarkers and to fully leverage their capabilities in informing the management of severe COVID-19 disease.