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BLOOD SCIENCES


Diagnostic testing in cases of SARS-CoV-2 adverse outcomes


Severe cases of COVID-19 disease exhibit a range of immunological, kidney, liver and heart complications that require laboratory investigation. Here, Randox Laboratories provides an overview and looks at the importance of quality control and assessment of testing.


The SARS-CoV-2 strain of coronavirus, which can lead to COVID-19 disease, presents in many as a minor cold or influenza; however, for those with health complications, including autoimmune diseases, asthma, heart disease and diabetes, the risk of developing serious illness and adverse outcomes is much greater. Currently, it is estimated that as many as one in six will experience complications that could be life-threatening.1


Because of


the spread and devastation of COVID-19, laboratory diagnostics plays an even more important role in the diagnosis and management of suspected cases or affected patients. As the spread and devastation of the SARS-CoV-2 pandemic continues to grow, it is vital that fast and accurate diagnostic testing strategies are implemented for effective risk stratification, monitoring of treatment and recovery.


Cytokine storms A cytokine storm, a hyperactive immune response, is a serious complication associated with SARS-CoV-2, triggering life-threatening pneumonia, acute respiratory distress syndrome (ARDS) and multiple organ failure.2,3


such inflammatory markers can indicate the presence of a cytokine storm and allow timely therapeutic intervention.4 It is estimated that cytokine storms


56


occur in up to 5% of severe COVID-19 cases, with high levels of several inflammatory cytokines including interleukin (IL)-6, IL-8, IL-10 and tumour necrosis factor-alpha (TNFα) identified. Owing to the elevation of several pro- inflammatory and anti-inflammatory cytokines, a multiplex immunoassay approach can offer several advantages over the widely utilised single enzyme- linked immunosorbent assay (ELISA) tests. The simultaneous detection of multiple cytokines from a single patient sample will provide clinicians with a detailed picture and complete patient profile, facilitating a personalised medicine approach.5,6


Renal function


The National Institute for Health and Care Excellence (NICE) recommends that all COVID-19 patients be assessed for acute kidney injury (AKI) on admission to hospital and their condition monitored throughout their stay. Acute kidney injury is a common complication of COVID-19, especially in diabetic patients.7 Serum creatinine (SCr) is the commonly utilised screening test for renal impairment; however, it is important to consider the accuracy and reliability of the method. The Jaffe and enzymatic methods are the readily available methods of SCr determination; and while the Jaffe method is less expensive, it is more susceptible to interferences. These interferences can lead to the misdiagnosis of patients, which is not ideal in the current pandemic.7 Moreover, the sensitivity of SCr in the early detection of renal disease is poor, as SCr is insensitive to small changes in glomerular filtration rate (GFR), with up to 50% of renal function potentially lost before significant SCr levels become detectable.8,9


Cystatin C (CysC) is a superior marker


of renal function and has been identified to be useful in the determination of the extent of renal damage, as well as distinguishing between those with severe and mild COVID-19.10


Although CysC is a superior marker Early detection of


Early detection of inflammatory markers can indicate the presence of a cytokine storm and allow timely therapeutic intervention.


of renal impairment, employing a multi- marker approach could identify renal disease or injury at a much earlier stage. Using current technologies, renal disease is typically diagnosed at around stage 4 or 5, when moderate to severe damage has already occurred. Using a multiplex approach, damage can be identified much earlier and in many cases before symptoms arise.


DECEMBER 2020 WWW.PATHOLOGYINPRACTICE.COM


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