• Yoshito Miyata, Hideki Inoue, Kuniaki Hirai, Fumihiro Ishikawa, Shin Ohta, Haruna Sato, Kaoru Mochizuki, Takaya Ebato, Hatsuko Mikuni, Tomoyuki Kimura, Yosuke Fukuda, Yasunari Kishino, Tetsuya Homma, Hideto Oyamada, Sojiro Kusumoto, Mayumi Yamamoto, Shintaro Suzuki, Yuko Udaka, Akihiko Tanaka, Keiko Ishino, Yuji Kiuchi, and Hironori Sagara.
• Department of Internal Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan. Electronic address: ym820127@med.showa-u.ac.jp.
• Am. J. Med. Sci. 2022 Dec 1; 364 (6): 706713706-713.

BackgroundIn Japan, during the coronavirus disease 2019 (COVID-19) pandemic, patients with non-hypoxia are recommended to recuperate at home or in pre-hospital facilities. However, it was observed that unexpected hypoxia may occur and become severe subsequently in patients whose symptoms were initially expected to improve naturally. The aim of this study is to validate biomarkers that can predict at an early stage the emergence of hypoxia in COVID-19 patients without hypoxia.MethodsWe retrospectively enrolled 193 patients with COVID-19, excluding patients with hypoxia and severe disease from the onset. Participants were classified into two groups according to the emergence of hypoxia during the clinical course, and the laboratory data were compared to identify biomarkers that could predict early the emergence of hypoxia.ResultsThe areas under the curve for serum cystatin C (CysC) and C-reactive protein (CRP) levels for the emergence of hypoxia during the clinical course were higher than those for other biomarkers (CysC, 0.84 and CRP, 0.83). Multivariate analysis showed that high serum CysC and CRP levels were associated with the emergence of hypoxia during the clinical course.ConclusionsElevated serum CysC and CRP levels were associated with the emergence of hypoxia during the clinical course in COVID-19 patients without hypoxia. These findings may help determine the need for hospitalization in initially non-hypoxic COVID-19 patients.Copyright © 2022. Published by Elsevier Inc.

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