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. 2025 Mar 4;14(5):1717.
doi: 10.3390/jcm14051717.

The Predictive Role of C-Reactive Protein, Leukocyte Cell Count, and Soluble Urokinase Plasminogen Activator Receptor for Pulmonary Sequelae in Hospitalized COVID-19 Survivors: A Prospective Single-Center Cohort Study

Izzet Altintas  1   2 , Thomas Kallemose  1 , Mette Bendtz Lindstrøm  1 , Imran Parvaiz  2 , Iben Rokkedal  2 , Lene Juel Rasmussen  3 , Katrine Kjær Iversen  4 , Jesper Eugen-Olsen  1   5 , Kasper Karmark Iversen  5   6 , Ejvind Frausing Hansen  7 , Charlotte Suppli Ulrik  6   7 , Jan Olof Nehlin  1 , Ove Andersen  1   2   6
Affiliations

The Predictive Role of C-Reactive Protein, Leukocyte Cell Count, and Soluble Urokinase Plasminogen Activator Receptor for Pulmonary Sequelae in Hospitalized COVID-19 Survivors: A Prospective Single-Center Cohort Study

Izzet Altintas et al. J Clin Med. .

Abstract

Background: Pulmonary function impairment significantly affects quality of life, work ability, and healthcare utilization. Among patients with COVID-19, respiratory symptoms vary in severity. This study aimed to assess whether biomarkers related to respiratory function and inflammation at emergency department (ED) admittance can predict long-term pulmonary function impairment in COVID-19 survivors. Methods: This prospective single-center study recruited patients 4-5 months post-COVID-19 infection using consecutive sampling. All attendees at the respiratory outpatient clinic were invited to participate. Pulmonary function tests, including diffusing capacity of the lungs for carbon monoxide (DLCO), total lung capacity (TLC), forced expiratory volume in the first second (FEV1), and forced vital capacity (FVC), were performed, with DLCO < 80% as the key indicator of impairment. Baseline biomarkers-C-Reactive Protein (CRP), leukocyte counts, and soluble urokinase Plasminogen Activator Receptor (suPAR)-were correlated with post-discharge DLCO values. Results: This study enrolled 110 patients with COVID-19; 58.2% were female, the median age was 61.5, and the average BMI was 27.2. Smoking history showed that 53.7% were never smokers, 43.5% were former smokers, and 2.8% were current smokers. A diffusion deficit (DLCO < 80%) was present in 48.6% of patients. Leukocyte counts and suPAR had the highest sensitivity (>0.80) for predicting DLCO impairment but showed low specificity and a positive predictive value (PPV) of around 0.50. However, combining all biomarkers improved prediction accuracy, with a negative predictive value (NPV) of 0.93. Conclusions: The chosen inflammatory biomarkers by themselves had a limited ability to predict long-term pulmonary function impairment in COVID-19 survivors. However, when combined, they demonstrated a high negative predictive value (NPV) for identifying DLCO impairment. This strategy could help clinicians better tailor follow-up care for patients with COVID-19.

Keywords: COVID-19; CRP; DLCO; SARS-CoV-2; leukocyte cell count; prediction; pulmonary function impairment; suPAR.

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Conflict of interest statement

J.E.-O. and O.A. are named inventors on patents on suPAR owned by Copenhagen University Hospital, Hvidovre, Denmark, and licensed to ViroGates A/S. JEO is a CSO and shareholder in ViroGates A/S. All other authors declare no financial relationships with any organization that might have an interest in the submitted work in the previous 3 years. Additionally, they have no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1
Diagram illustrating the enrollment of patients in the study and their inclusion in the analysis. Abbreviations: DLCO: diffusing capacity of the lungs for carbon monoxide, CPR: central person register.
See this image and copyright information in PMC

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