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The research breakthrough was recently published in Circulation, the world’s leading cardiac medical journal.
The biomarker in question is called Growth Differentiation Factor 15 (GDF-15).
This is a substance that is excreted in the body in severe infections, acute illnesses, and heart disease.
GDF-15 stood out strongly and positively compared to a host of other biomarkers that researchers examined in the hope that they could play a significant role in the coronavirus disease that has devastated the entire world by 2020.
Researchers at Akershus University Hospital (Ahus) and the University of Oslo, led by Professor Torbjørn Omland and Dr. Peder L. Myhre, were originally planning a study in which the goal was to find a blood sample that could differentiate between patients who receive a mild and patients who develop a severe course of covid-19.
Dangerous complications
This summer, the researchers had disappointing results for several blood test markers examined, but at the same time they had identified GDF-15.
In the recent study, researchers analyzed the level of this substance in the blood of 123 hospitalized covid-19 patients in Ahus. 35 of these patients had a severe course of the disease. Four died.
The researchers found elevated GDF-15 concentrations in four out of five patients.
Furthermore, the researchers found that known and dangerous complications of COVID-19, such as low oxygen saturation in the blood (hypoxemia) and detection of the SARS CoV-2 coronavirus in the blood (viremia), were associated with higher concentrations. of GDF-15.
High concentrations of GDF-15 were also associated with the need for intensive care and a fatal outcome.
“We found that GDF-15 concentrations were not only associated with risk, but were strongly associated with important pathophysiological features of the disease, including hypoxemia, and provided much better prognostic information than established risk markers for covid-19, “the researchers write.
– Central role
– We have found that GDF-15 plays a central role in risk assessment in covid-19. This blood test marker can reveal early on which patients are at high risk for severe coronavirus disease, Omland tells Dagbladet.
The professor believes that it is an important finding that GDF-15 is elevated in patients who, despite not experiencing shortness of breath, have low blood oxygen saturation, which is common in severe coronavirus disease.
– These patients can be critically ill, without realizing it themselves, says Omland.
The Ahus researchers took blood samples from the patients at the beginning of hospitalization, on day three and day nine.
They found that GDF-15 values continued to rise in patients who ended on a ventilator or died, while the values remained at a stable low level in patients with a milder course.
– The study shows that there is a strong connection between GDF-15 samples taken early during the hospital stay and which patients need intensive care or are at higher risk of death. This is important knowledge during the ongoing pandemic. It can help in the selection of high- and low-risk patients, which can be crucial in a situation where the intensive care capacity of hospitals can be strained, says Omland.
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Penetration
The professor believes that the unusually strong prognostic value of GDF-15 is due to the fact that it integrates information about the immune response, viruses in the blood, low blood oxygen levels, and damage to key organs such as the heart.
– We believe that our findings are a breakthrough in the search for a robust prognostic marker in covid-19. It is also important that the GDF-15 method can be easily implemented in hospitals around the world and provide answers already in the emergency department on who is at high risk for severe covid-19, says Omland.
The professor points out that, based on these findings, he is listed as a co-inventor in a patent application “GDF-15 to predict the severity of the disease of a patient with COVID-19”, and that it will be about two years before it is clarified if the request is approved.
– It is always useful to find biomarkers that can improve the prognosis and follow-up of patients. If it is easier to identify who is at high risk of worsening the course of the disease after hospitalization, it is of course an advantage for both the therapist and the patient, says assistant health director Espen Rostrup Nakstad to Dagbladet and explains :
– A biomarker can rarely be used alone, but often provides good predictive value if used in conjunction with clinical parameters, such as oxygen saturation in this case.
Chief Physician Marius Myrstad from the Bærum Hospital Medical Department thinks the study by Ahus and UiO’s colleagues is interesting.
– In a situation with a large influx of patients and perhaps even limited capacity, aids that can help quickly identify patients who need a high level of monitoring and intensive care will be in high demand, says Myrstad.
COBRA top leader, covid-19 study at Bærum hospital.
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Confirm the findings
He points out that GDF-15 is a test that is not performed routinely, nor is it available in the laboratories of most Norwegian hospitals today.
– But the study confirms that there are good aids that can contribute to a better flow of patients and ensure that the individual patient receives good enough follow-up, and this is important, especially in a situation where many patients arrive at the hospital in a short time says Myrstad.
Researchers at Bærum Hospital were the first to publish data on COVID-19 patients admitted to this hospital.
In July, a study was published in the international Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (SJTREM), in which researchers found that the NEWS2 scoring tool, used in the hospital, is effective for early identification. of patients with covid-19 as they develop a severe course of the disease.
– Similar to what we have previously published, our colleagues at Ahus also found that a high NEWS score on revenue was associated with an increased risk of a severe course of coronavirus disease, Myrstad says and continues:
– Ahus’s study confirms several of our findings: in both hospitals, approximately one in four patients developed a very severe course of the disease. Like the patients who were admitted to Bærum Hospital, the covid-19 patients at Ahus also had long-term symptoms, usually one to two weeks before being admitted to the hospital. Fever and respiratory symptoms were the most common symptoms, Myrstad says.
The superior notes that a common weakness in the Norwegian studies is the relatively low number of patients included.
– This is because fortunately in Norway we have had relatively few patients admitted to hospital, compared to other countries, and we are happy about that. Although the number is low, it is a strength of both studies that the inclusion of patients has been complete, says Myrstad.
