Oxidative stress indexes as biomarkers of the severity in COVID-19 patients

Xin Liu; Ruohong Chen; Binghui Li; Jialiang Zhang; Peiting Liu; Bingchu Li; Fengfan Li; Weilin Zhang; Xing Lyu; Min Hu

doi:10.7150/ijms.102879

Oxidative stress indexes as biomarkers of the severity in COVID-19 patients

Int J Med Sci. 2024 Nov 11;21(15):3034-3045. doi: 10.7150/ijms.102879. eCollection 2024.

Authors

Xin Liu^{1

2}, Ruohong Chen^{1

2}, Binghui Li^{1

2}, Jialiang Zhang^{1

2}, Peiting Liu^{1

2}, Bingchu Li^{1

2}, Fengfan Li^{1

2}, Weilin Zhang^{1

2}, Xing Lyu^{1

2}, Min Hu^{1

2}

Affiliations

¹ Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
² Center for Clinical Molecular Diagnostics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.

Abstract

Background: SARS-CoV-2 causes a global pandemic, with severe and critically ill COVID-19 patients often experiencing poor prognoses. Severe infection with SARS-CoV-2 is associated with oxidative stress (OS) and inflammation. Detecting markers of macromolecular damage caused by OS may provide valuable insights into disease progression. Methods: This study included 187 patients with laboratory-confirmed SARS-CoV-2 infection, categorized into non-severe, severe, and critically ill COVID-19 groups. We monitored the changes in serum indexes such as oxidized low-density lipoprotein (OxLDL), OxLDL/LDL-C ratio, advanced oxidation protein products (AOPP), 3-nitrotyrosine (3-NT), 8-hydroxydeoxyguanosine (8-OHdG), lipoprotein-associated phospholipase A₂ (Lp-PLA₂) and thromboxane B₂ (TXB₂) in patients with different clinical types. Results: 48 non-severe patients, 90 severe patients, and 49 critically ill patients were enrolled. Compared with the non-severe group, OxLDL level and OxLDL/LDL-C ratio were increased in severe COVID-19 patients and critically ill COVID-19 patients, while 3-NT and TXB₂ concentrations were lower in critically ill COVID-19 patients. Critically ill COVID-19 patients also exhibited lower concentrations of Lp-PLA₂ and a higher OxLDL/LDL-C ratio compared to severe COVID-19 patients. No significant differences were observed in AOPP and 8-OHdG concentrations. Spearman's correlation analysis revealed that CRP was associated with OxLDL, OxLDL/LDL-C ratio, AOPP, 3-NT, TXB₂, and Lp-PLA₂ (P <0.05). OxLDL was identified as an independent risk factor for progression from non-severe to severe/critically ill COVID-19. OxLDL and OxLDL/LDL-C ratio demonstrated good discriminatory value between non-severe and severe/critically ill COVID-19, with the OxLDL/LDL-C ratio also distinguishing between severe and critically ill patients. Conclusion: Patients with severe and critically ill COVID-19 exhibit elevated levels of oxidative damage to lipoproteins. OxLDL and the OxLDL/LDL-C ratio can serve as biomarkers for assessing disease severity in COVID-19 patients.

Keywords: 3-nitrotyrosine; COVID-19; oxidative stress; oxidized low-density lipoprotein.

MeSH terms

1-Alkyl-2-acetylglycerophosphocholine Esterase / blood
Adult
Advanced Oxidation Protein Products / blood
Aged
Biomarkers* / blood
COVID-19* / blood
COVID-19* / diagnosis
Critical Illness
Female
Humans
Lipoproteins, LDL* / blood
Male
Middle Aged
Oxidative Stress*
SARS-CoV-2*
Severity of Illness Index*

Substances

Biomarkers
oxidized low density lipoprotein
Lipoproteins, LDL
1-Alkyl-2-acetylglycerophosphocholine Esterase
Advanced Oxidation Protein Products