Fecal Calprotectin as a Marker of Severity of COVID-19 Disease: A Hospital-based Study

Document Type : Original Clinical

Authors

1 Internal Medicine Department, Faculty of Medicine, Zagazig University, Egypt.

2 Clinical Pathology Department, Faculty of Medicine, Zagazig University, Egypt

Abstract

Background: Although fecal calprotectin has prognostic value in assessing inflammatory bowel disease, the relationship of fecal calprotectin level with the severity of COVID-19 disease has not been determined yet. This study aimed to determine if fecal calprotectin may be used as a marker for the severity of COVID-19 disease.
Patients and Methods: A total of 50 patients with COVID-19 disease who presented with gastrointestinal manifestations, with or without respiratory manifestations and other symptoms, were categorized into four groups: 14 patients with mild symptoms, 12 patients with moderate manifestations, 12 patients with severe manifestations, and 12 critically ill patients in the intensive care unit (ICU). Fecal calprotectin, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), D-dimer, ferritin, and complete blood count (CBC) were measured at baseline and after 21 days, along with clinical follow-up.
Results: A substantial decrease in fecal calprotectin levels from baseline to 21 days across all cases and subgroups. Notably, critical patients exhibited significantly higher fecal calprotectin levels compared to severe, moderate, and mild cases at baseline and after 21 days (p-value <0.001). Additionally, critical patients had significantly elevated ESR, CRP, ferritin, and D-dimer levels compared to other groups. The duration of hospitalization was significantly longer for vital and severe patients compared to moderate and mild cases. Furthermore, the mortality rate within 21 days was significantly higher in critical and severe cases compared to other groups.
Conclusion: Our findings indicate a substantial correlation between fecal calprotectin levels and the severity of COVID-19. Notably, fecal calprotectin levels were considerably higher in the critical group compared to other groups, both at baseline and after 21 days. So, fecal calprotectin may be used as a marker for the severity of COVID-19 disease.

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Footnotes. Mohamed Emara (professor of gastroenterology, hepatology, and infectious diseases), Nabila Hassan (professor of gastroenterology, hepatology, and infectious diseases), and Amany Mohamed( assistant professor of community medicine) were the peer reviewers. E- Editor: Salem Youssef Mohamed, Osama Ahmed Khalil, Amany Mohammed. Copyright ©. This open-access article is distributed under the Creative Commons Attribution License (CC BY). It may be used, distributed, or reproduced in other forums, provided the original author(s) and the copyright owner(s) are credited. The original publication in this journal must be cited according to accepted academic practice. Disclaimer: The authors' claims in this article are solely their own and do not necessarily represent their affiliated organizations or those of the publisher, the editors, and the reviewers. Any product evaluated in this article or its manufacturer's claim is not guaranteed or endorsed by the publisher. Ethical considerations The Zagazig institutional review board approved the study (ZU-IRB#9084-8-8-2021). All individual participants in the study provided written informed consent. Ethical approval: All procedures involving human participants followed the institutional and national research committee's moral standards, the 1964 Helsinki Declaration, and its later amendments or comparable ethical standards. All authors declare that consent was obtained from the patient (or other approved parties) to publish this study. Data and materials availability: The datasets used or analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: This study had no funding from any resource. This work was done according to the STROBE guidelines. Authors' contributions: AH conceived the research concept, while AG and AA conducted the clinical examinations and monitored the patients. AG and RA collaborated to gather the necessary laboratory data. All authors actively participated in analyzing and interpreting the patient information and composing the manuscript. All authors thoroughly reviewed and approved the final version of the manuscript. Acknowledgments We thank our esteemed colleagues who have diligently worked in the COVID-19 isolation units at Zagazig University for their invaluable assistance in data collection and analysis. We also extend our sincere appreciation to all the patients who graciously participated in this research study.

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