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. 2023 Aug 18;24(16):12935.
doi: 10.3390/ijms241612935.

Serum Total Antioxidant Capacity (TAC) and TAC/Lymphocyte Ratio as Promising Predictive Markers in COVID-19

Zoltán Horváth-Szalai  1   2 , Rita Jakabfi-Csepregi  1   2 , Balázs Szirmay  1   2 , Dániel Ragán  1   2 , Gerda Simon  3 , Zoltán Kovács-Ábrahám  3 , Péter Szabó  3 , Dávid Sipos  4 , Ágnes Péterfalvi  1 , Attila Miseta  1 , Csaba Csontos  3 , Tamás Kőszegi  1   2 , Ildikó Tóth  3
Affiliations

Serum Total Antioxidant Capacity (TAC) and TAC/Lymphocyte Ratio as Promising Predictive Markers in COVID-19

Zoltán Horváth-Szalai et al. Int J Mol Sci. .

Abstract

SARS-CoV-2 infection might cause a critical disease, and patients' follow-up is based on multiple parameters. Oxidative stress is one of the key factors in the pathogenesis of COVID-19 suggesting that its level could be a prognostic marker. Therefore, we elucidated the predictive value of the serum non-enzymatic total antioxidant capacity (TAC) and that of the newly introduced TAC/lymphocyte ratio in COVID-19. We included 61 COVID-19 (n = 27 ward, n = 34 intensive care unit, ICU) patients and 29 controls in our study. Serum TAC on admission was measured by an enhanced chemiluminescence (ECL) microplate assay previously validated by our research group. TAC levels were higher (p < 0.01) in ICU (median: 407.88 µmol/L) than in ward patients (315.44 µmol/L) and controls (296.60 µmol/L). Besides the classical parameters, both the TAC/lymphocyte ratio and TAC had significant predictive values regarding the severity (AUC-ROC for the TAC/lymphocyte ratio: 0.811; for TAC: 0.728) and acute kidney injury (AUC-ROC for the TAC/lymphocyte ratio: 0.747; for TAC: 0.733) in COVID-19. Moreover, the TAC/lymphocyte ratio had significant predictive value regarding mortality (AUC-ROC: 0.752). Serum TAC and the TAC/lymphocyte ratio might offer valuable information regarding the severity of COVID-19. TAC measured by our ECL microplate assay serves as a promising marker for the prediction of systemic inflammatory diseases.

Keywords: COVID-19; TAC/lymphocyte ratio; enhanced chemiluminescence; predictive value; serum total antioxidant capacity (TAC).

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Serum total antioxidant capacity levels (A), absolute lymphocyte counts (B), and total antioxidant capacity (TAC)/lymphocyte ratios (C) in controls, ward, and intensive care unit COVID-19 patients; receiver operating characteristic (ROC) curves of admission laboratory and clinical parameters for differentiating ICU from ward COVID-19 patients (D). * p < 0.05, ** p < 0.01, *** p < 0.001. SOFA score: Sequential organ failure assessment score.
Figure 2
Figure 2
TAC/lymphocyte ratios in COVID-19 patients suffering from mild to no (Horowitz Index > 200 mmHg) and moderate-severe (Horowitz Index ≤ 200 mmHg) acute respiratory distress syndrome (ARDS) (A) and diagnostic capacity of the studied markers regarding ARDS investigated by ROC analysis (B). ** p < 0.01. SOFA score—sequential organ failure assessment score.
Figure 3
Figure 3
TAC/lymphocyte ratios in COVID-19 patients with and without acute kidney injury (AKI) (A); diagnostic capacity of the studied parameters regarding AKI (B). ** p < 0.01.
Figure 4
Figure 4
TAC/lymphocyte ratios in survivor vs. non-survivor COVID-19 patients (A) and receiver operating characteristic curves of admission laboratory and clinical parameters for predicting hospital mortality in COVID-19 patients (B). *** p < 0.001. SOFA score—sequential organ failure assessment score.
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