The Importance of Diagnostic Testing in SARS-CoV-2 Adverse Outcomes

Home - COVID19

The Importance of Diagnostic Testing in SARS-CoV-2 Adverse Outcomes

SARS-CoV-2 (COVID-19), a highly contagious disease, primarily manifests as an acute respiratory illness, 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. It is estimated that 1 in 6 will experience adverse outcomes that could be life-threatening 1. The spread and devastation of COVID-19 highlights the vital role laboratory diagnostics plays in the diagnosis and management of suspected and affected patients. As the COVID pandemic continues, it is imperative that fast and accurate diagnostic testing strategies are implemented for effective risk stratification and monitoring of treatment and recovery.

In this article, we will review how Randox Reagents can aid in diagnosing and managing SARS-CoV-2 adverse outcomes.

 

Cytokine Storms

The immune system activates a pro-inflammatory response to enhance host immunity against viruses and decrease colonisation and infection, but only if the pro-inflammatory response is controlled. Uncontrolled pro-inflammatory responses can result in a cytokine storm 2. A cytokine storm is a serious complication associated with SARS-CoV-2, which can trigger life-threatening pneumonia, acute respiratory distress syndrome (ARDS) and multiple organ failure 3, 4. Cytokine storms occur in 5% of severe COVID-19 cases, with several inflammatory cytokines observed at high levels. Due to the elevation of several pro-inflammatory and anti-inflammatory cytokines, a multiplex immunoassay approach can offer several advantages over the widely utilised single ELISA tests. The simultaneous detection of multiple cytokines from a single patient sample will provide clinicians with a comprehensive overview of cytokine markers and complete patient profile, facilitating a personalised treatment plan to be implemented 5, 6.

Cytokine Storms Image

Inflammation

In COVID-19 patients, CRP testing has proved to perform well in discriminating disease severity and predicting adverse outcomes 7. Elevated CRP levels have been identified in 86% of patients admitted to hospital. CRP measurements are useful in diagnosis, prognosis and monitoring for clinical improvements or deterioration. Moreover, the acute phase reactant, ferritin, has been observed to increase in approximately 60% of COVID-19 patients. In the critically ill COVID-19 patients, extremely elevated ferritin concentrations were recorded, which could be attributed to a cytokine storm and secondary haemophagocytic lymphohistiocytosis (a hyper-inflammatory syndrome associated with multi-organ failure) 8.

Renal Function

Acute kidney injury (AKI) is a common complication in diabetic patients who test positive for COVID-19. Regardless, the National Institute for Health and Care Excellence (NICE) recommend AKI testing in all COVID-19 patients upon hospital admission and their condition monitored throughout their stay 9.

The most commonly utilised screening test for renal impairment is serum creatinine (SCr); however, it is important to consider the accuracy and reliability of the method. Two commercially available methods exist for SCr determination: Jaffe and enzymatic. Whilst the Jaffe method is less expensive, it is more susceptible to interferences which can lead to the misdiagnosis of patients, which isn’t ideal in the current pandemic 7. Moreover, the sensitivity of SCr, regardless of method, in the early detection of renal disease is poor, as SCr is insensitive to small changes in glomerular filtration rate (GFR). Up to 50% of renal function can potentially be lost before significant SCr levels become detectable 8, 9. In comparison, cystatin C (CysC) is a superior marker of renal function and is useful in the determination of the extent of renal damage, as well as distinguishing those with severe and mild COVID-19 10.

Hepatic Function

Liver Image

Abnormal liver function tests significantly increases a COVID-19 patients risk of developing severe disease and complications such as pneumonia 11. Bilirubin levels, 3 times the upper limit have been observed in COVID-19 patients 11, 12. Whilst the diazo method is commonly utilised in bilirubin testing, superior methods exist. The vanadate oxidation (VO) method offers several advantages particularly in haemolytic and lipemic samples. These advantages are particularly evident in neonatal and infant populations where haemolysis is extremely common. Moreover, the VO method offers a wider analytical measurement range for the comfortable detection of clinically important results 13.

Other liver function markers are known to be elevated in COVID-19 patients including both AST and ALT, with markers like albumin decreased.

The Importance of Lp(a) Testing

Lipoprotein(a) / Lp(a), a strong independent marker of cardiovascular disease risk has recently been identified as a key risk marker of cardiovascular complications in COVID-19 patients. Those with either baseline elevated or elevated levels of Lp(a) following COVID-19 infection may be at a significantly increased risk of developing thromboses. Consideration should be given to measurement of Lp(a) and prophylactic anticoagulation of infected patients to reduce the risk. Elevated Lp(a) levels may also cause acute destabilization of pre-existing but quiescent, atherosclerotic plaques, which could induce an acute myocardial infarction (AMI) or cerebrovascular accident (CVA) (stroke) 14.

The size heterogeneity of apo(a) isoforms represents the biggest challenge faced by laboratories in accurately measuring Lp(a).  The variable numbers of repeated KIV-2 units in act as multiple epitopes, and so standardisation across calibrators is vital. Unless the calibrants have the same range of isoforms as test samples, those with higher numbers of the KIV-2 repeat, will represent with an overestimation in Lp(a) concentrations and those with smaller numbers of the KIV-2 repeat, will represent with an underestimation. The smaller isoforms are strongly associated with higher Lp(a) concentrations 15.

Lp(a) assays that are standardised to the WHO/IFCC (World Health Organization/International Federation of Clinical Chemistry) reference material, transferring values from mg/dl to nmol/l are more uniform. The assay considered the most reliable commercially available Lp(a) assay is so because: 15

1. The isoform size variations are reduced as a range of calibrators from separate pools of serum used, which covered a range of Lp(a) concentrations.

2. The isoform size and concentrations are inversely correlated, better matching calibrants with test samples.

3. Methods are calibrated in nmol/l and traceable to WHO/IFCC reference material and give acceptable bias compared with the Northwest Lipid Metabolism and Diabetes Research Laboratory (NLMDRKL) gold standard method.

Want to know more?

Contact us or visit our COVID-19 disease management webpage.

Related Products

Extended Coronavirus Array

Qnostics SARS-CoV-2 Control

AKI Array


G-6-PDH Assay

Reagent | G6PDH

A Biomarker of G6PDH Deficiency

Benefits of the Randox G6PDH Assay

Correlation

Exceptional correlation

A correlation coefficient of r=0.9903 was displayed when the Randox G6PDH assay was compared to commercially available methods.

Measuring range

Excellent measuring range

The Randox G6PDH assay has a measuring range of 154 – 4303U/l for the comfortable detection of clinically important results.

Precision

Excellent precision

The Randox G6PDH assay displayed a precision of <4.65% CV.

Stability

Excellent stability

The Randox G6PDH assay has a reconstituted stability of 4 weeks when stored at +2oC to +8oC.

Calibrator & Controls

Dedicated G6PDH controls available

Dedicated G6PDH controls available offering a complete testing package.

Logos-07

Applications available

Applications available detailing instrument-specific settings for the convenient use of the Randox G6PDH assay on a variety of clinical chemistry analysers.

Ordering Information

Cat NoSize    
PD410R1 1 x 100ml
R2 1 x 2ml
EnquireKit Insert RequestMSDSBuy Online
PD2616750T
Screen Test
EnquireKit Insert RequestMSDSBuy Online

Instrument Specific Applications (ISA’s) are available for a wide range of biochemistry analysers.  Contact us to enquire about your specific analyser.

Diagnostics Uses

  • Physiological Significance
  • G6PDH Deficiency
  • Malaria
  • COVID-19

The G6PD gene provides the instructions for marking the glucose-6-phosphate dehydrogenase (G6PDH) enzyme 1. G6PDH is a cytosolic enzyme located on the long arm of the X-chromosome of bodily cells and so is an inherited x-linked disorder. G6PDH is involved in the normal processing of carbohydrate and the prevention of cellular damage from reactive oxygen species (ROS). In doing so, G6PDH provides substrates to prevent oxidative damage. G6PDH plays a critical role in red blood cells, protecting them from damage and premature destruction. The two main products of G6PDH are:  ribose-5-phosphatase which is important for DNA, the chemical cousin of RNA; and NADPH which protects the body from ROS 1, 2.

Glucose-6-phosphate dehydrogenase (G6PDH/G6PD) deficiency is the most common enzyme deficiency in the pentose phosphate pathway, affecting more than 400 million people globally.  G6PDH deficiency is an X-linked recessive disorder mainly affecting RBC’s 2.

A defect in the G6PDH enzyme results in premature haemolysis (break down of RBC’s).  If the bone marrow cannot compensate for the reduction of RBC’s, haemolytic anaemia can occur.  Many individuals that are glucose-6-phosphate dehydrogenase deficient are asymptomatic most of the time, however when they are exposed to certain triggering factors, they can develop acute haemolytic anaemia (AHA), which can be life-threatening, especially in children.  Symptoms associated with G6PDH deficiency can include paleness, jaundice, dark urine, fatigue, shortness of breath, a sudden rise in body temperature, lower back pain, splenomegaly (enlarged spleen) and a rapid heart rate.  Other symptoms can include nausea, diarrhoea or abdominal discomfort.  It has been noted that glucose-6-phosphate dehydrogenase deficiency is a significant cause of mild to severe jaundice in new-borns. Early and accurate diagnosis of G6PDH deficiency is essential in ensuring the successful management of haemolytic anaemia 1, 2.

Of all malaria cases reported in Latin America and the Caribbean, 42% are attributed to Brazil. However, in recent years, progress has been made towards the elimination of the malaria burden, reaching the lowest levels in the past 35 years (143, 910 cases and 41 confirmed malaria-related deaths). Whilst the transmission area of malaria has significantly reduced, 99.5% of Brazil’s malaria burden is attributed to the Amazon Basin 3. The predominant contributor to the malaria outbreak in Brazil is attributed to the plasmodium vivax parasites which can cause severe and fatal complications in glucose-6-phosphate dehydrogenase (G6PDH) deficient individuals. Individuals infected with malaria are treated with primaquine, however, in G6PDH deficient individuals, this treatment can induce haemolytic anaemia, and so, G6PDH screening is vital 4.

A Brazilian study, published in the Malaria Journal prospectively evaluated 516 male volunteers within the Alto do Juruá, an area characterized by a high prevalence of plasmodium vivax, to determine the prevalence of G6PDH. The study found that 4.5% of the study group were G6PDH deficient and were at a high risk of haemolytic anaemia if treated with primaquine. As such, the routine screening of G6PDH deficiency in Brazil to personalize the treatment of patients with vivax malaria, is crucial for malaria elimination 4.

Chloroquine, an anti-malaria drug, has been selected to aid in treating those with COVID-19 following preliminary research and a limited study in Australia which highlighted that chloroquine showed promise in eradicating the virus. Moreover, Chinese research highlighted the efficacy and safety of chloroquine in treating pneumonia in COVID-19 patients 5.

It is believed that COVID-19 is expected to spread to areas where G6PDH deficiency is more common, however, serious consideration must be given to treatment decisions using chloroquine as chloroquine-induced haemolysis is the result to decreased G6PDH activity 6.

Useful Links

G6PDH Control

Featured Reagent Home

Reagents Home

Reagents Resource Hub


Request a meeting
×
Make an Enquiry - RX series
×
Make an Enquiry - Reagents
×
Kit Insert Request - Reagents
  • Signing up to our mailing list is quick and easy. We do not wish to send you any spam or junk email, therefore, you can expect to receive mailshots including new product launches and updates, market trends, attendance at key industry events and much more. Randox Laboratories promise never to sell your data and we will keep all your details, safe and secure. Read more in our Privacy Policy.
×
Kit Insert Request - Reagents
  • Signing up to our mailing list is quick and easy. We do not wish to send you any spam or junk email, therefore, you can expect to receive mailshots including new product launches and updates, market trends, attendance at key industry events and much more. Randox Laboratories promise never to sell your data and we will keep all your details, safe and secure. Read more in our Privacy Policy.
×
Make an Enquiry - Reagents
×
Make an Enquiry - Quality Control
×
Make an Enquiry - RIQAS
×
Make an Enquiry - RIQAS
×
Make an Enquiry - Quality Control
×
Make an Enquiry
  • Signing up to our mailing list is quick and easy. We do not wish to send you any spam or junk email, therefore, you can expect to receive mailshots including new product launches and updates, market trends, attendance at key industry events and much more. Randox Laboratories promise never to sell your data and we will keep all your details, safe and secure. Read more in our Privacy Policy.
×
Make an Enquiry - Biochip
  • This field is for validation purposes and should be left unchanged.
×
Make an Enquiry - Molecular
  • Signing up to our mailing list is quick and easy. We do not wish to send you any spam or junk email, therefore, you can expect to receive mailshots including new product launches and updates, market trends, attendance at key industry events and much more. Randox Laboratories promise never to sell your data and we will keep all your details, safe and secure. Read more in our Privacy Policy.
  • This field is for validation purposes and should be left unchanged.
×
Make an Enquiry - Future Diagnostics
×
Make an Enquiry - RX series (Product)
×
Make an Enquiry - Quality Control
  • Signing up to our mailing list is quick and easy. We do not wish to send you any spam or junk email, therefore, you can expect to receive mailshots including new product launches and updates, market trends, attendance at key industry events and much more. Randox Laboratories promise never to sell your data and we will keep all your details, safe and secure. Read more in our Privacy Policy.
×
Make an Enquiry - RIQAS
  • Signing up to our mailing list is quick and easy. We do not wish to send you any spam or junk email, therefore, you can expect to receive mailshots including new product launches and updates, market trends, attendance at key industry events and much more. Randox Laboratories promise never to sell your data and we will keep all your details, safe and secure. Read more in our Privacy Policy.
×
Make an Enquiry - Reagents
  • Signing up to our mailing list is quick and easy. We do not wish to send you any spam or junk email, therefore, you can expect to receive mailshots including new product launches and updates, market trends, attendance at key industry events and much more. Randox Laboratories promise never to sell your data and we will keep all your details, safe and secure. Read more in our Privacy Policy.
×
Por favor, introduzca sus datos para ver nuestro último seminario
×
Wyślij zapytanie
  • Rejestracja na naszej liście mailowej jest szybka i łatwa. Nie chcemy wysyłać e-maili zawierających spam lub wiadomości, które są automatycznie przekierowywane do kosza. W zawiązku z czym firma Randox deklaruje, że będzie wysyłac tylko informacje na temat nowych produktów,akutalizacji obecnych, trendów rynkowych, wydarzeń branżowych itp. Firma Randox Laboraotries obiecuje, że Państwa dane nie będą nigdzie przekazane, a przechowywanie owych danych będzie się odbywało z zachowaniem największego bezpieczeństwa. Prosimy o przeczytani naszje Polityki Prywatności.
×
Wyślij zapytanie
  • Rejestracja na naszej liście mailowej jest szybka i łatwa. Nie chcemy wysyłać e-maili zawierających spam lub wiadomości, które są automatycznie przekierowywane do kosza. W zawiązku z czym firma Randox deklaruje, że będzie wysyłac tylko informacje na temat nowych produktów,akutalizacji obecnych, trendów rynkowych, wydarzeń branżowych itp. Firma Randox Laboraotries obiecuje, że Państwa dane nie będą nigdzie przekazane, a przechowywanie owych danych będzie się odbywało z zachowaniem największego bezpieczeństwa. Prosimy o przeczytani naszje polityki prywatności.
×
Wyślij zapytanie
  • Rejestracja na naszej liście mailowej jest szybka i łatwa. Nie chcemy wysyłać e-maili zawierających spam lub wiadomości, które są automatycznie przekierowywane do kosza. W zawiązku z czym firma Randox deklaruje, że będzie wysyłac tylko informacje na temat nowych produktów,akutalizacji obecnych, trendów rynkowych, wydarzeń branżowych itp. Firma Randox Laboraotries obiecuje, że Państwa dane nie będą nigdzie przekazane, a przechowywanie owych danych będzie się odbywało z zachowaniem największego bezpieczeństwa. Prosimy o przeczytani naszje polityki prywatności.
×
Wyślij zapytanie
    Rejestracja na naszej liście mailowej jest szybka i łatwa. Nie chcemy wysyłać e-maili zawierających spam lub wiadomości, które są automatycznie przekierowywane do kosza. W zawiązku z czym firma Randox deklaruje, że będzie wysyłac tylko informacje na temat nowych produktów,akutalizacji obecnych, trendów rynkowych, wydarzeń branżowych itp. Firma Randox Laboraotries obiecuje, że Państwa dane nie będą nigdzie przekazane, a przechowywanie owych danych będzie się odbywało z zachowaniem największego bezpieczeństwa. Prosimy o przeczytani naszje polityki prywatności .
×
귀하의 문의 사항 제출
    Signing up to our mailing list is quick and easy. We do not wish to send you any spam or junk email, therefore, you can expect to receive mailshots including new product launches and updates, market trends, attendance at key industry events and much more. Randox Laboratories promise never to sell your data and we will keep all your details, safe and secure. Read more in our Privacy Policy.
×
귀하의 문의 사항 제출
×
귀하의 문의 사항 제출
×
귀하의 문의 사항 제출
×
Downloads
×
Contact

<p>

    Randox Clinical Chemistry Products Join the Randox Laboratories Mailing List * I would like to receive emails with new product releases and updates from Randox Laboratories, market trends, and more. I do not want to receive email marketing from Randox. Signing up to our mailing list is quick and easy. We do not want to send you any spam or junk emails, therefore, you can expect to receive mailshots including new product launches and updates, market trends, attendance at key industry events and much more. Randox Laboratories promises never to sell your data and we will keep all your details, safe and secure. Read more in our Privacy Policy.
</p>

×
Enquire Now - Coronavirus Testing
  • Signing up to our mailing list is quick and easy. We do not wish to send you any spam or junk email, therefore, you can expect to receive mailshots including new product launches and updates, market trends, attendance at key industry events and much more. Randox Laboratories promise never to sell your data and we will keep all your details safe and secure. Read more in our Privacy Policy.
×