The Predictive Role of C-Reactive Protein, Leukocyte Cell Count, and Soluble Urokinase Plasminogen Activator Receptor for Pulmonary Sequelae in Hospitalized COVID-19 Survivors: A Prospective Single-Center Cohort Study.

Background

Pulmonary function impairment significantly affects quality of life, work ability, and healthcare utilization. Among patients with COVID-19, respiratory symptoms vary in severity. This study aimed to assess whether biomarkers related to respiratory function and inflammation at emergency department (ED) admittance can predict long-term pulmonary function impairment in COVID-19 survivors.

Methods

This prospective single-center study recruited patients 4-5 months post-COVID-19 infection using consecutive sampling. All attendees at the respiratory outpatient clinic were invited to participate. Pulmonary function tests, including diffusing capacity of the lungs for carbon monoxide (DLCO), total lung capacity (TLC), forced expiratory volume in the first second (FEV1), and forced vital capacity (FVC), were performed, with DLCO < 80% as the key indicator of impairment. Baseline biomarkers-C-Reactive Protein (CRP), leukocyte counts, and soluble urokinase Plasminogen Activator Receptor (suPAR)-were correlated with post-discharge DLCO values.

Results

This study enrolled 110 patients with COVID-19; 58.2% were female, the median age was 61.5, and the average BMI was 27.2. Smoking history showed that 53.7% were never smokers, 43.5% were former smokers, and 2.8% were current smokers. A diffusion deficit (DLCO < 80%) was present in 48.6% of patients. Leukocyte counts and suPAR had the highest sensitivity (>0.80) for predicting DLCO impairment but showed low specificity and a positive predictive value (PPV) of around 0.50. However, combining all biomarkers improved prediction accuracy, with a negative predictive value (NPV) of 0.93.

Conclusions

The chosen inflammatory biomarkers by themselves had a limited ability to predict long-term pulmonary function impairment in COVID-19 survivors. However, when combined, they demonstrated a high negative predictive value (NPV) for identifying DLCO impairment. This strategy could help clinicians better tailor follow-up care for patients with COVID-19.