Biological markers may let doctors know who gets sicker from COVID-19

For some, COVID-19 can come and go leaving no trace and no symptoms. For others, the disease responsible for the worldwide pandemic can lead to a range of painful symptoms, a trip to an intensive care unit, and even death.
How to tell who will be spared and who will be hard hit?

That is something doctors, scientists, and people the world over want to know. With so many variables involved, it’s a tricky question to answer, but researchers and physicians at The University of Texas Medical Branch at Galveston are looking for biological indicators that could identify vulnerable patients faster and allow health care providers to intervene quicker and more aggressively.

What they have found thus far is that in the most severe cases of COVID-19, patients tend to have life-threatening blood clots in the lungs and brain. The blood coagulation is likely triggered by the heightened immune response in the patients.

“I started working with my other colleagues at UTMB and wanted to know what is going on with the patients who get severely ill. Can we measure it? Can we somehow treat it?” said Dr. Lawrence Sowers, professor of Pharmacology and Medicine at UTMB. “If we could identify which patients were likely to develop severe disease and have some way to treat them, then we could really defang this disease.”

Sowers and a team of UTMB colleagues began a systematic study of how SARS-CoV-2 causes disease and how treatment approaches might be developed. The group published their findings in June 2020 in a paper entitled

“Pharmacological Approaches to the Treatment of COVID-19 Patients” in the Journal of Translational Sciences.

Data on the disease has revealed that older people and those with preexisting diseases are more likely to develop severe disease. Emerging clinical studies from the U.S. have also shown that Black patients were developing severe disease and dying at an alarmingly high rate.

While there are certainly socio-economic factors at play, Sowers said biological factors could also be part of the reason why some COVID-19 patients end up in the ICU while others never experience symptoms.

Although the genetic basis for this association is not yet known, previous studies have linked a heightened procoagulant state in Black patients with an increased likelihood of blood clots.

After researchers found that patients with the most severe of cases of COVID-19 tended to have life-threatening blood clots, Sowers and his collaborators identified biological markers that physicians could look for and test.

For example, health care workers could identify patients that needed more aggressive treatment by measuring oxygen saturation levels and looking for a biomarker known as a D-dimer present in patients that have blood clots, Sowers said.
While many treatment approaches have looked at stopping the spread and replication of the virus in patients, another approach is to deal with and reduce the heightened inflammation, which appeared to be responsible for the unusually high number of patients who developed severe disease and died.

Targeted testing and interventions are already having a positive result with patients and Sowers said UTMB is building a biobank of blood and other tissues from participating COVID-19 patients so that researchers can continue to look for new, more sophisticated biomarkers that will help health care providers in their effort to treat COVID-19 patients.

“If we can ID high-risk patients before there are symptoms and catch the disease before it progresses to a more dangerous place, we could start more aggressive, targeted interventions sooner,” Sowers said. “If mortality in COVID-19 patients can be substantially reduced with appropriate therapy, the impact of SARS-CoV-2 on the world will be greatly diminished.”