Dados do Trabalho

Título

NEUROFILAMENT LIGHT CHAIN (NFL), GLIAL FIBRILLARY ACIDIC PROTEIN (GFAP), UBIQUITIN CARBOXY-TERMINAL HYDROLASE L1 (UCH-L1) ANDTAU PROTEIN LEVELS IN A SEVERE COVID 19 PATIENT WITH DOUBLE HOSPITALIZATION AND FAVORABLE OUTCOME

RESUMO

Coronavirus disease 19 (COVID-19) is an infectious disease caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome related to Coronavirus 2). Most SARS-COV-2 infected people experience mild self-limiting respiratory illness. Some, however, become seriously ill and require medical attention. Here we present the case of a 71-years-old male patient with comorbidities (chronic arterial hypertension, diabetes mellitus, previous stroke), and previous history of admission in Intensive Care Unit (ICU), intubation and coma due to COVID-19 in 2020. One year later, in July 2021, he had been admitted to the Clementino Fraga Filho University Hospital ICU for the same reason, when also presented myoclonic seizure; at that time, he was intubated for 2 weeks. Positive PCR for COVID-19 confirmed a second infection. Cranium Computed Tomography (September 2021) showed no acute changes but diffuse atrophy. MRI wasn’t possible at the time. During the second ICU admission (2021), his blood sample was collected, so we could investigate neurological and immunological biomarkers (Neurofilament light chain - NFL; Glial fibrillary acidic protein - GFAP; Ubiquitin carboxy-terminal hydrolase L1 - UCH-L1; TAU protein; Interleukin-22 - IL-22), those were measured using SIMOA (SIngle MOlecule Array), an ultrasensitive technique for biomarkers quantification in peripheral blood. The patient showed the following levels for these biomarkers: NFL- 131,23pg/mL; GFAP- 615,12pg/mL; UCHL1- 115,24pg/mL; TAU- 1,36pg/mL; IL-22- 385.71pg/mL. Most of these values are considered high, when compared to age-matched control group, with the reference values of GFAP- 192,75pg/mL; NfL- 17,52pg/mL; Tau- 1,89pg/mL; UCHL1- 41,56pg/mL and IL-22- 7.49pg/mL. The only biomarker considered at normal levels was TAU protein, in agreement with expected due to his preserved memory and absence of dementia even after the second COVID-19 event. However, the GFAP, NfL, and UCHL1 were significantly higher when compared to the control. These are important markers of neuroinflammation and may be related to the myoclonic seizure and coma. It is important to highlight that he presented high IL-22 levels and that this IL has been considered a protective factor during SARS-COV-2 infection, and probably an important biomarker for this favorable outcome. These intense variations together with the clinical picture of the patient may be an indication of the relevance of these biomarkers for the progression and outcome of COVID-19.

Palavras Chave

COVID-19; BIOMARKERS; NEUROFILAMENTS; GFAP; TAU PROTEIN; UCH-L1