Considering novelty and complexity of a new koronavirusny infection, the medical and scientific community needs to find in the nearest future reliable biomarkers which indicate progressing of a koronavirusny disease (COVID-19) quickly to allocate the patients entering into group of high risk. High speed of spread of an infection causes the necessity of division of patients into risk groups according to the diagnosis for optimum distribution of the available resources.
New biomarkers are necessary for identification of patients who are more subject to higher speed of progressing of a disease and emergence of serious complications and death. Identification of new biomarkers is closely connected with understanding of a virus pathogeny and also the mechanism of damage of cells and bodies. Effective biomarkers could help when carrying out screening, clinical maintaining patients and also with prevention of serious complications.
The template of pathological changes of hematologic, biochemical, inflammatory and immune biomarkers in comparison with patients with the moderate system course of a disease which is included in models of allocation of risk groups was found in patients with a severe disease. In this article we will consider known today changes of biochemical indicators which can be considered as certain markers of a koronavirusny infection.
The main changes in laboratory parameters of the heavy patients or patients who died from COVID-19 were recently investigated during meta-analysis, including, in three big researches in which comparison of the recovered and died patients was made. At the died patients significant growth in the general bilirubin and a creatine kinase, serumal ferritin, number of leukocytes and SILT-6 in comparison with the recovered patients was revealed. Besides, considering strong communication between a thromboembolism and, to a lesser extent, injury of a myocardium and COVID 19, D-dimery and cardiomarkers also play a key role in observation of a condition of patients with COVID 19.
Markers of injury of a cardiac muscle, in particular, of a myocardium, were raised at patients with a heavy current of COVID-19 and with a lethal outcome. At primary inspection at the died late patients the level of a cardiospecific troponin was much higher that, most likely, is result of viral myocarditis and injury of a myocardium owing to progressing of a disease and its overflowing in multiorgan insufficiency. At multiorgan insufficiency substantial increase of enzymes of a liver (ALT and nuclear heating plant) is connected with critical changes in functioning of kidneys (an urea nitrogen, creatinine). It is also possible to track changes in markers of coagulability of blood.
Chen et al. observed on selection of 799 patients (113 of which died, and 161 recovered) noticeable increase in concentration of ALT, nuclear heating plant, creatinine, a creatine kinase, LDG, cardiospecific troponin of I, N-trailer fragments of brain natriuretic peptide and D-dimera at the died late patients in comparison with the recovered patients.
Authors of Du et al. in a perspective research of 179 patients with the pneumonia caused by COVID-19 (including 21 patient who died later), found cardiospecific troponin I at the level of 0.05 ng/ml among four risk factors predicting a lethal outcome (age of 65 years, the existing accompanying cardiovascular diseases or disturbances of cerebral circulation.
Function of a liver is also established as important risk factor of a lethal outcome at COVID-19. During the recent research it was assumed that the SARS-CoV-2 virus can contact directly ACE2 positive holangiotsita, and, as a result, cause disturbance of work of a liver in patients with COVID-19. It can result from dysfunction of holangiotsit and for other reasons, for example, as a result of medicinal damage of a liver or damage of a liver as a result of reciprocal system inflammatory reaction. As for the specific and dynamic nature of markers of damage of a liver, authors of Lei et al., during the extensive retrospective multicenter research with participation of data of 5771 patients, reported that the nuclear heating plant is closely connected with risk of death in comparison with other parameters, pointing to damage of a liver. This proof contrasts with the proof of increase in ALT in other cases of damage of a liver, for example, as a result of development of hepatitis.
Thus today is defined COVID-19 given rather biochemical markers and it makes sense to continue further researches in this direction.