학술논문
Association of SARS-CoV-2 nucleocapsid viral antigen and the receptor for advanced glycation end products with development of severe disease in patients presenting to the emergency department with COVID-19
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article
Author
Matthay, Zachary A; Fields, Alexander T; Wick, Katherine D; Jones, Chayse; Lane, H Clifford; Herrera, Kimberly; Nuñez-Garcia, Brenda; Gennatas, Efstathios; Hendrickson, Carolyn M; Kornblith, Aaron E; Matthay, Michael A; Kornblith, Lucy Z; Group, the COVID-19 Associated Coagulopathy Inflammation Thrombosis Study; Ambachew, Biniam; Bainton, Roland J; Cary, Sarah; Chalwell, Lauren; Colwell, Christopher; Josephy, Clayton; Kurien, Philip; Lee, Deanna; LeGrand, Matthieu; Montoy, Juan Carlos; Nguyen, Viet; Park, John J; Prakash, Arun; Robinson, Brittany; India, Shelley
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Abstract
IntroductionThere remains a need to better identify patients at highest risk for developing severe Coronavirus Disease 2019 (COVID-19) as additional waves of the pandemic continue to impact hospital systems. We sought to characterize the association of receptor for advanced glycation end products (RAGE), SARS-CoV-2 nucleocapsid viral antigen, and a panel of thromboinflammatory biomarkers with development of severe disease in patients presenting to the emergency department with symptomatic COVID-19.MethodsBlood samples were collected on arrival from 77 patients with symptomatic COVID-19, and plasma levels of thromboinflammatory biomarkers were measured.ResultsDifferences in biomarkers between those who did and did not develop severe disease or death 7 days after presentation were analyzed. After adjustment for multiple comparisons, RAGE, SARS-CoV-2 nucleocapsid viral antigen, interleukin (IL)-6, IL-10 and tumor necrosis factor receptor (TNFR)-1 were significantly elevated in the group who developed severe disease (all p80% on cut-point analysis.DiscussionElevated RAGE and SARS-CoV-2 nucleocapsid viral antigen on emergency department presentation are strongly associated with development of severe disease at 7 days. These findings are of clinical relevance for patient prognostication and triage as hospital systems continue to be overwhelmed. Further studies are warranted to determine the feasibility and utility of point-of care measurements of these biomarkers in the emergency department setting to improve patient prognostication and triage.