The utility of syndecan-1 circulating levels as a biomarker in patients with previous or active COVID-19: a systematic review and meta-analysis

Elina Ghondaghsaz; Amirmohammad Khalaji; Mitra Norouzi; Douglas D Fraser; Sanam Alilou; Amir Hossein Behnoush

doi:10.1186/s12879-023-08473-9

The utility of syndecan-1 circulating levels as a biomarker in patients with previous or active COVID-19: a systematic review and meta-analysis

BMC Infect Dis. 2023 Aug 4;23(1):510. doi: 10.1186/s12879-023-08473-9.

Authors

Elina Ghondaghsaz^#¹, Amirmohammad Khalaji^#², Mitra Norouzi³, Douglas D Fraser^{4

5

6

7

8}, Sanam Alilou⁹, Amir Hossein Behnoush¹⁰

Affiliations

¹ Undergraduate Program in Neuroscience, University of British Columbia, Vancouver, BC, Canada.
² School of Medicine, Tehran University of Medical Sciences, Poursina St., Keshavarz Blvd, Tehran, 1417613151, Iran.
³ Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran.
⁴ Children's Health Research Institute, London, ON, Canada.
⁵ Lawson Health Research Institute, London, ON, Canada.
⁶ Department of Pediatrics, Western University, London, ON, Canada.
⁷ Department of Physiology & Pharmacology, Western University, London, ON, Canada.
⁸ Department of Clinical Neurological Sciences, Western University, London, ON, Canada.
⁹ School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
¹⁰ School of Medicine, Tehran University of Medical Sciences, Poursina St., Keshavarz Blvd, Tehran, 1417613151, Iran. amirhossein.behnoush@gmail.com.

^# Contributed equally.

Abstract

Background: With the emergence of coronavirus disease of 2019 (COVID-19), several blood biomarkers have been identified, including the endothelial biomarker syndecan-1, a surface proteoglycan. In the current systematic review and meta-analysis, we aimed to assess the diagnostic and prognostic role of syndecan-1 in COVID-19.

Methods: PubMed, Embase, Scopus, and Web of Science, as international databases, were searched for relevant studies measuring blood syndecan-1 levels in COVID-19 patients, COVID-19 convalescents, and healthy control subjects, in patients with different COVID-19 severities and/or in COVID-19 patients with poor outcomes. Random-effect meta-analysis was performed using STATA to calculate the standardized mean difference (SMD) and 95% confidence interval (CI) for the comparison between COVID-19 patients and healthy control subjects or COVID-19 convalescents and controls.

Results: After screening by title/abstract and full text, 17 studies were included in the final review. Meta-analysis of syndecan-1 levels in COVID-19 compared with healthy control subjects revealed that patients with COVID-19 had significantly higher syndecan-1 levels (SMD 1.53, 95% CI 0.66 to 2.41, P < 0.01). In contrast, COVID-19 convalescent patients did not show significant difference with non-convalescents (SMD 0.08, 95% CI -0.63 to 0.78, P = 0.83). Regarding disease severity, two studies reported that more severe forms of the disease were associated with increased syndecan-1 levels. Moreover, patients who died from COVID-19 had higher syndecan-1 levels compared with survivors (SMD 1.22, 95% CI 0.10 to 2.33, P = 0.03).

Conclusion: Circulating syndecan-1 level can be used as a biomarker of endothelial dysfunction in COVID-19, as it was increased in COVID-19 patients and was higher in more severe instances of the disease. Further larger studies are needed to confirm these findings and further enlighten the role of syndecan-1 in clinical settings.

Keywords: COVID-19; Diagnosis; Glycocalyx; Meta-analysis; Prognosis; Syndecan-1; Systematic review.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Biomarkers
COVID-19* / diagnosis
Humans
Patients
Prognosis
Syndecan-1

Substances

Biomarkers
Syndecan-1
SDC1 protein, human