Download PDF
CC BY-NC-ND 4.0 · Journal of Coloproctology 2021; 41(04): 361-366
DOI: 10.1055/s-0041-1736646
Original Article

Fecal Calprotectin as a Predictor of COVID-19 Severity

Mohammed Hussien Ahmed 
1   Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
,
Hebat Allah Abdel Maksoud Ahmed
2   Department of Community Medicine, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
,
Nahla Abd el-Aziz Nosair
3   Department of Clinical Pathology, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
,
Asmaa Mbarak Hassan
3   Department of Clinical Pathology, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
,
Dalia ElSayed Sherief
3   Department of Clinical Pathology, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
,
Aya Mohammed Mahros 
1   Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Coronavirus disease 2019 (COVID-19) is highly transmittable through contact with respiratory droplets. The virus is also shed in fecal matter. Some patients may present with effects in more than one system; however, there are no defined biomarkers that can accurately predict the course or progression of the disease. The present study aimed to estimate the severity of the disease, to correlate the severity of the disease with biochemical predictors, to identify valuable biomarkers indicative of gastrointestinal disease, and to determine the cutoff values. A cross-sectional study was conducted on COVID-19 patients admitted to the Kafrelsheikh University Hospital (isolation unit) between July 10, 2020, and October 30, 2020. The diagnosis of COVID-19 was confirmed via reverse transcription-polymerase chain reaction (RT-PCR), which was employed for the detection of the viral RNA. We conclude that lymphopenia, elevated C-reactive protein (CRP) level, and liver enzymes were among the most important laboratory findings in COVID-19 patients. Statistically significant differences in platelet count, neutrophil count, D-dimer level, and fecal calprotectin levels were observed among patients presenting with chest symptoms only and patients with both chest and gastrointestinal symptoms (p = 0.004; < 0.001; 0.010; 0.003; and < 0.001, respectively). C-reactive protein, D-dimer, and fecal calprotectin levels positively correlated with disease severity. The cutoff value for fecal calprotectin that can predict gastrointestinal involvement in COVID-19 was 165.0, with a sensitivity of 88.1% and a specificity of 76.5%.

Keywords

coronavirus disease 2019 - severe acute respiratory syndrome coronavirus 2 - predictors in reflection of the severity in Covid 19 patients

Authors Contributions

Maksoud H. A. A. analyzed the data and Hussien M. interpreted the patient data. Mohamed A and Sherief D. E. collected the data. Nossier N. A. and Mabrok A. contributed with the writing of the manuscript.


All authors read and approved the final manuscript




Publication History

Received: 30 January 2021

Accepted: 15 June 2021

Article published online:
13 December 2021

© 2021. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Abd-Elsalam S, Esmail ES, Khalaf M. et al. Tanta Protocol for Management of COVID-19: Perspectives from a Developing Country. Endocr Metab Immune Disord Drug Targets 2020; ••• DOI: 10.2174/1871530320999201117142305.
    CrossrefPubMedGoogle Scholar
  • 2 Elshaarawy O, Lashen SA, Makhlouf NA. et al. Barriers for resuming endoscopy service in the context of COVID-19 pandemic: A multicenter survey from Egypt. World J Gastroenterol 2020; 26 (43) 6880-6890
    CrossrefPubMedGoogle Scholar
  • 3 Hamming I, Timens W, Bulthuis ML, Lely AT, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol 2004; 203 (02) 631-637
    CrossrefPubMedGoogle Scholar
  • 4 Sarin SK, Choudhury A, Lau GK. et al; APASL COVID Task Force, APASL COVID Liver Injury Spectrum Study (APCOLIS Study-NCT 04345640). Pre-existing liver disease is associated with poor outcome in patients with SARS CoV2 infection; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study). Hepatol Int 2020; 14 (05) 690-700
    CrossrefPubMedGoogle Scholar
  • 5 Marjot T, Moon AM, Cook JA. et al. Outcomes following SARS-CoV-2 infection in patients with chronic liver disease: An international registry study. J Hepatol 2021; 74 (03) 567-577
    CrossrefPubMedGoogle Scholar
  • 6 Hanafy AS, Abd-Elsalam S. Challenges in COVID-19 drug treatment in patients with advanced liver diseases: A hepatology perspective. World J Gastroenterol 2020; 26 (46) 7272-7286
    CrossrefPubMedGoogle Scholar
  • 7 Bauer W, Diehl-Wiesenecker E, Ulke J. et al. Outcome prediction by serum calprotectin in patients with COVID-19 in the emergency department. J Infect 2021; 82 (04) 84-123
    CrossrefPubMedGoogle Scholar
  • 8 World Health Organization. Clinical Management of Severe Acute Respiratory Infection (SARI) When COVID-19 Disease Is Suspected: Interim Guidance, 13 March 2020. World Health Organization; 2020
    CrossrefGoogle Scholar
  • 9 National Health Commission of the People's Republic of China. Notice on the novel coronavirus infection diagnosis and treatment plan (trial version seventh). In: National Health Commission of the People's Republic of China, editor. Beijing, 2020. Available From: http://www.nhc.gov.cn/wjw/gfxwjj/list_5.shtml
    Google Scholar
  • 10 Huang C, Wang Y, Li X. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223): 497-506
    CrossrefPubMedGoogle Scholar
  • 11 Liu J, Li S, Liu J. et al. Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients. EBioMedicine 2020; 55: 102763 DOI: 10.1016/j.ebiom.2020.102763.
    CrossrefPubMedGoogle Scholar
  • 12 Wan S, Yi Q, Fan S. et al. Characteristics of lymphocyte subsets and cytokines in peripheral blood of 123 hospitalized patients with 2019 novel coronavirus pneumonia (NCP). Accessed 24 Mar 2020 From: https://www.medrxiv.org/content/10.1101/2020.02.10.20021832v1(2020)
    Google Scholar
  • 13 Hoffmann M, Kleine-Weber H, Schroeder S. et al. SArS-CoV-2 cell entry depends on ACe2 and tMPrSS2 and is blocked by a clinically proven protease inhibitor. Cell 2020; 181 (02) 271-280.e8 DOI: 10.1016/j.cell.2020.02.052.
    CrossrefPubMedGoogle Scholar
  • 14 Zhang H, Kang Z, Gong H. et al. Digestive system is a potential route of COVID-19: an analysis of single-cell coexpression pattern of key proteins in viral entry process. Gut 2020; 69: 1010-1018
    CrossrefGoogle Scholar
  • 15 Querol-Ribelles JM, Tenias JM, Grau E. et al. Plasma d-dimer levels correlate with outcomes in patients with community-acquired pneumonia. Chest 2004; 126 (04) 1087-1092 DOI: 10.1378/chest.126.4.1087.
    CrossrefPubMedGoogle Scholar
  • 16 Chen W, Zheng KI, Liu S, Yan Z, Xu C, Qiao Z. Plasma CRP level is positively associated with the severity of COVID-19. Ann Clin Microbiol Antimicrob 2020; 19 (01) 18 DOI: 10.1186/s12941-020-00362-2.
    CrossrefPubMedGoogle Scholar