Performance of serum apolipoprotein-A1 as a sentinel of Covid-19

PLoS One. 2020 Nov 20;15(11):e0242306. doi: 10.1371/journal.pone.0242306. eCollection 2020.

Abstract

Background: Since 1920, a decrease in serum cholesterol has been identified as a marker of severe pneumonia. We have assessed the performance of serum apolipoprotein-A1, the main transporter of HDL-cholesterol, to identify the early spread of coronavirus disease 2019 (Covid-19) in the general population and its diagnostic performance for the Covid-19.

Methods: We compared the daily mean serum apolipoprotein-A1 during the first 34 weeks of 2020 in a population that is routinely followed for a risk of liver fibrosis risk in the USA (212,297 serum) and in France (20,652 serum) in relation to a local increase in confirmed cases, and in comparison to the same period in 2019 (266,976 and 28,452 serum, respectively). We prospectively assessed the sensitivity of this marker in an observational study of 136 consecutive hospitalized cases and retrospectively evaluated its specificity in 7,481 controls representing the general population.

Results: The mean serum apolipoprotein-A1 levels in the survey populations began decreasing in January 2020, compared to the same period in 2019. This decrease was highly correlated with the daily increase in confirmed Covid-19 cases in the following 34 weeks, both in France and USA, including the June and mid-July recovery periods in France. Apolipoprotein-A1 at the 1.25 g/L cutoff had a sensitivity of 90.6% (95%CI84.2-95.1) and a specificity of 96.1% (95.7-96.6%) for the diagnosis of Covid-19. The area under the characteristics curve was 0.978 (0.957-0.988), and outperformed haptoglobin and liver function tests. The adjusted risk ratio of apolipoprotein-A1 for survival without transfer to intensive care unit was 5.61 (95%CI 1.02-31.0; P = 0.04).

Conclusion: Apolipoprotein-A1 could be a sentinel of the pandemic in existing routine surveillance of the general population. NCT01927133, CER-2020-14.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Apolipoprotein A-I / blood*
  • Betacoronavirus
  • Biomarkers / blood
  • COVID-19
  • Coronavirus Infections / blood*
  • Coronavirus Infections / epidemiology
  • Female
  • France
  • Humans
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / blood*
  • Pneumonia, Viral / epidemiology
  • Retrospective Studies
  • SARS-CoV-2
  • United States

Substances

  • APOA1 protein, human
  • Apolipoprotein A-I
  • Biomarkers

Associated data

  • ClinicalTrials.gov/NCT01927133

Grants and funding

EIT Health is funding short-term projects to help combat the COVID-19 pandemic as part of its Rapid Response initiative (https://eithealth.eu/covid-19/covid-19-rapid-response/). The present article is the first step of the PROCOP project, focusing on apolipoprotein-A1 performances, belong to the 15 projects selected cover biotechnology, diagnostics, digital health and med tech, and are run by 41 partners (https://eithealth.eu/project/procop/. The projects work directly with healthcare services as part of the consortia, so that the solutions can be built in line with clinical needs and implemented without delay. The EIT Health Partner of PROCOP is Assistance Publique Hôpitaux de Paris (APHP; (Leader of the project), a French Public Organization. The following authors are full employees of APHP: MR, MV, SA, VC, MS, DBR, JML, DS, YA, OB, FG, JM, OL, BF, VR, DT and PC. The EIT Health Partner is BioPredictive, a spinoff research company of APHP and Sorbonne University, founded by TP (APHP and Sorbonne University). All the patents invented by TP belong to APHP. The following authors are full employees of BioPredictive: OD, VP; and YN. The following authors contributed to Funding acquisition, and Project administration: JMC, FD, CF. The following authors contributed, to Resources, References review & editing (VP), and OD (Conceptualization; Data curation; Methodology; Software).