Role of fecal calprotectin as a hypoxic intestinal damage biomarker in COVID-19 patients

• Published in: Gut pathogens 2022-08, Vol.14 (1), p.1-34, Article 34
• Main Authors: Adriana, Deasy Natalia, Sugihartono, Titong, Nusi, Iswan Abbas, Setiawan, Poernomo Boedi, Purbayu, Herry, Maimunah, Ummi, Kholili, Ulfa, Widodo, Budi, Thamrin, Husin, Vidyani, Amie, Maulahela, Hasan, Yamaoka, Yoshio, Miftahussurur, Muhammad
• Format: Article
• Language: English
• Subjects: Acute respiratory distress syndrome; Analysis; Bacterial pneumonia; Biomarkers; Communicable diseases; Coronaviruses; COVID-19; Disease; Fecal calprotectin; Feces; Hospital patients; Hypoxemia; Hypoxia; Immunoassay; Infectious disease; Inflammation; Intestine; Ischemia; Laboratories; Medical research; Medicine, Experimental; Neutrophils; P/F ratio; Pandemics; Pneumonia; Proteins; Respiratory distress syndrome; Severe acute respiratory syndrome coronavirus 2; Statistical analysis; Teaching hospitals
• ISSN: 1757-4749; 1757-4749
• DOI: 10.1186/s13099-022-00507-y

Background Gastrointestinal manifestations of coronavirus disease 2019 (COVID-19) appear to be substantial. Fecal calprotectin is a promising biomarker in COVID-19 associated gastrointestinal inflammation; however, its role in the severity of COVID-19 remains limited. We conducted a study to analyze the relationship between the severity of COVID-19 and hypoxic intestinal damage. Methods We assessed the severity of 44 hospitalized COVID-19 pneumonia patients based on the PaO2/FiO2 (P/F) ratio. Inflammatory markers were measured from blood samples, and fecal calprotectin was obtained from stool samples. Results Median levels of fecal calprotectin in COVID-19 patients involved in this study (n = 44) were found to be markedly elevated along with the severity of hypoxemia, as seen in the non-acute respiratory distress syndrome (ARDS) group 21.4 [micro]g/g (5.2-120.9), mild ARDS 54.30 [micro]g/g (5.2-1393.7), moderate ARDS 169.6 [micro]g/g (43.4-640.5), and severe ARDS 451.6 [micro]g/g (364.5-538.6). We also found significant differences in fecal calprotectin levels based on the severity of ARDS (P < 0.001), and although the patients were divided into ARDS and non-ARDS groups (P < 0.001). Furthermore, we found a strong negative correlation between the P/F ratio and fecal calprotectin levels (r = - 0.697, P < 0.001). Conclusion Our findings support the potential role of fecal calprotectin as a biomarker of intestinal inflammation in COVID-19 as a consequence of hypoxic intestinal damage and as suggested by the reduced P/F ratio. Keywords: Fecal calprotectin, P/F ratio, COVID-19, Infectious disease