Potential Predictive Value of Netrin-1 and Hematological Biomarkers in COVID-19-Associated Immune Dysregulation

Abstract

This study intended to evaluate levels of Netrin-1, glycated hemoglobin, and some hematological parameters in COVID-19 patients by comparing them with the control or healthy group to investigate the potential effects of infection. The biochemical tests studied included of Netrin-1 protein level, random blood sugar (RBS), HbA1c, C-reactive protein levels, and concentrations of some hematological parameters (RBC, WBC, Platelets, and Hemoglobin). The study was applied on 40 patients (20 males and 20 females) with COVID-19 at Samarra Hospital and some outpatient clinics in Samarra city, in addition to 30 healthy individuals (15 males and 15 females) as a control group, for the period from the beginning of October 2022 to the end of January 2023. They were in four groups of males and females aged between 20 and 50 years. The results showed significant sex-dependent changes in Netrin-1 levels. Netrin-1 concentrations were considerably lower in COVID-19 male patients compared to healthy men, whereas female patients had significantly higher levels compared to female controls (P < 0.001). CRP and RBS levels were significantly elevated in both male and female patients (P <0.001). Male patients had significantly higher HbA1c levels (P = 0.003) whereas females had a non-significant rise (P = 0.072). Hematological investigations indicated significant leukocytosis, lymphopenia and thrombocytopenia in both sexes. In female patients, there was also a substantial decrease in hemoglobin levels while in male patients there was a large increase in RBC count and PCV levels.

Correlation study showed substantial inverse connection between Netrin-1 and both CRP and HbA1c levels confirming the link between changed Netrin-1 expression and inflammatory dysregulation in COVID-19 patients . ROC curve research revealed promising predictive and diagnostic values of CRP, lymphocyte percentage, Netrin-1 and platelet count for immunological changes related with COVID-19.

In conclusion, COVID-19 infection is associated with severe inflammatory and hematological abnormalities that are linked to sex-dependent changes in Netrin-1 levels. These data imply that Netrin-1 may be a promising prognostic biomarker related to immunological dysregulation in COVID-19 patients.