Predicting COVID-19 Hospitalized Patients’ Outcome with Homocysteine

Background: Homocysteine (Hcy) has been reported as a potential predictive biomarker for CoViD-19 infection severity in many studies. Hyper-homocysteinemia is related to many virus infection outcomes, including HEV, HPV and HIV. Recent data confirmed the value of Hcy in predicting the risk of severe pneumonia. Materials and Methods: Our retrospective cohort study, including 313 CoViD-19 hospitalized patients (female 34.8%;mean age 62 years), also included a broad panel of clinical laboratory data collected. Of the enrolled patients, 10.9% died during hospitalization (3% were transferred to other hospitals and were lost to follow-up). Results: Hcy was found to be the strongest predictor of CoViD- 19 critical-progression leading to death. Univariate analysis demonstrated that age (OR 1.04), Hcy (OR 1.06), and neutrophil/lymphocyte count ratio (OR 1.03) were significant predictors of critical progression leading to death and RBC (OR 0.68) and lymphocytes count (OR 0.23) with benign outcome. ROC analysis indicated Hcy cut off of 16 μmol/L for predicting CoViD- 19 infection outcome (sensitivity 40% and specificity 84%);patients with Hcy levels >16 μmol/L had significantly increased risk of in-hospital mortality (p=0.002) both as a continuous and dichotomic value. Conclusions: Our results demonstrate that Hcy is an effective predictive biomarker for hospitalized CoViD-19 patients' outcome. Hcy may be a valuable biomarker to help clinicians to identify patients who are at higher risk for severe CoViD-19 infection.