Plasma proteomic profiles correlate with organ dysfunction in COVID-19 ARDS.

Summary

In 32 COVID-19 ARDS patients, aptamer-based plasma proteomics identified proteins and pathways tracking organ dysfunction: ephrin and acute phase signaling increased with worsening SOFA, whereas fibrosis and wound-healing signatures tracked improvement. Persistent inflammation emerged as a driver of severity, highlighting candidate biomarkers for future ARDS cohorts.

Key Findings

• Aptamer-based profiling of 7,289 proteins in plasma from 32 COVID-19 ARDS patients identified 184 proteins correlated with day-1 SOFA and 46 with day-7 SOFA.
• Longitudinal changes in 40 proteins tracked changes in SOFA between days 1 and 7.
• Pathways of ephrin and acute phase response correlated positively with worsening SOFA, whereas pulmonary fibrosis signaling and wound healing correlated negatively (improvement).

Clinical Implications

Candidate plasma biomarkers may enable noninvasive monitoring and stratification of ARDS patients, guiding timing and selection of anti-inflammatory versus pro-repair therapies.

Limitations

• Small single-center cohort (n=32) with risk of multiple testing and overfitting
• COVID-19-specific cohort may limit generalizability to non-COVID ARDS; no external validation

Future Directions

Validate protein panels in independent ARDS cohorts (COVID and non-COVID), evaluate predictive utility for clinical endpoints, and integrate proteomics with genomics and metabolomics.