Interleukin-21: A Potential Biomarker For Diagnosis and Predicting Prognosis in COVID-19 Patients.

Acet Öztürk, Nilüfer Aylin; Ursavaş, Ahmet; Görek Dilektaşli, Asli; Demirdöğen, Ezgi; Coşkun, Necmiye Funda; Ediger, Dane; Uzaslan, Ayşe Esra; Yöyen Ermiş, Diğdem; Karaca, Mert; Terzi, Orkun Eray; Bayram, Merve; Ömer Topçu, Dilara; Yiğitliler, Büşra; Yurttaş, Ahmet; Maharramov, Shahriyar; Yazici, Gamze; Oral, Haluk Barbaros; Karadağ, Mehmet

Interleukin-21: A Potential Biomarker For Diagnosis and Predicting Prognosis in COVID-19 Patients Abstract Introduction COVID-19 patients have a wide spectrum of disease severity. Several biomarkers were evaluated as predictors for progression towards severe disease. IL-21 is a member of common ?-chain cytokine family and creates some specific effects during programming and maintenance of antiviral immunity. We aimed to assess IL-21 as a biomarker for diagnosis and outcome prediction in patients hospitalized with COVID-19. Method Patients with a preliminary diagnosis of COVID-19 and pneumonia other than COVID-19 admitted to a tertiary care hospital were included consecutively in this comparative study. Results The study population consisted of 51 patients with COVID-19 and 11 patients with non-COVID-19 pneumonia. Serum IL-21 concentration was markedly higher and serum CRP concentration was significantly lower in COVID-19 patients compared to non-COVID-19 pneumonia patients. Within COVID-19 patients 10 patients showed radiological and clinical progression. Patients with clinical worsening had lower lymphocyte count and haemoglobin. In addition to that deteriorating patients had higher urea, LDH levels and elevated concentration of both IL-6 and IL-21. The cut-off value of 106 ng/L for IL-21 has 80.0% sensitivity, %60.9 specificity for discriminating patients with clinical worsening. Multivariable analysis performed to define risk factors for disease progression identified IL-6 and IL-21 as independent predictors. Odds ratio for serum IL-6 concentrations ? 3.2 pg/mL was 8.07 (95% CI: 1.37-47.50, p=0.04) and odds ratio for serum IL-21 concentrations ? 106 ng/L was 6.24 (95% CI: 1.04 ? 37.3, p=0.02). Conclusion We identified specific differences in serum IL-21 between COVID-19 and non-COVID-19 pneumonia patients. Serum IL-21 measurement has promising predictive value for disease progression in COVID-19 patients. High serum IL-6 and IL-21 levels obtained upon admission are independent risk factors for clinical worsening.