Usefulness of the Measurement of Serum Paraoxonase-1 Arylesterase Activity in the Diagnoses of COVID-19

Abstract

The development of inexpensive, fast, and reliable screening tests for COVID-19 is, as yet, an unmet need. The present study was aimed at evaluating the usefulness of serum arylesterase activity of paraoxonase-1 (PON1) measurement as a screening test in patients with different severity levels of COVID-19 infection. We included 615 COVID-19-positive patients who were classified as asymptomatic, mildly symptomatic, severely symptomatic, or fatally symptomatic. Results were compared with 50 healthy volunteers, 330 patients with cancer, and 343 with morbid obesity. Results showed PON1 activity greatly decreased in COVID-19 compared to healthy volunteers; a receiver operating characteristics plot showed a high diagnostic accuracy. The degree of COVID-19 severity did not influence PON1 levels. Our results indicated that PON1 determination was efficient for disease diagnosis, but not for prognosis. Furthermore, patients with obesity or cancer presented alterations similar to those of COVID-19 patients. As such, elevated levels of PON1 indicate the absence of COVID-19, but low levels may be present in various other chronic diseases. The assay is fast and inexpensive. We suggest that PON1 measurement could be used as an initial, high cut-off point screening method, while lower values should be confirmed with the more expensive nucleic acid amplification test.

Keywords: COVID-19; SARS-CoV-2; biomarkers; paraoxonase-1.

Figure 1

Serum paraoxonase-1 (PON1) activities and Receiver Operating Characteristics (ROC) curves comparing COVID-19-positive patients and the healthy controls; (A): All patients combined; (B): Asymptomatic patients; (C): Mild disease; (D): Severe disease; (E): Fatal disease. AUC: Area under the curve.

Figure 2

Serum paraoxonase-1 (PON1) and Receiver Operating Characteristics (ROC) curves comparing asymptomatic and mild versus severe and fatal COVID-19-positive patients. AUC: Area under the curve.

Figure 3

Serum paraoxonase-1 (PON1) activities in COVID-19 patients segregated according to the severity of symptoms and the days post-onset of the infection.

Figure 4

Serum paraoxonase-1 (PON1) activities in COVID-19-positive patients and all COVID-19-negative patients (obesity + cancer) and healthy volunteers combined (A); Receiver Operating Characteristics (ROC) curves comparing COVID-19-positive patients and COVID-19-negative patients (B); Serum paraoxonase-1 (PON1) activities in COVID-19-positive and COVID-19-negative patients separated according to their disease (C). AUC: Area under the curve.