Alpha 1-antitrypsin as a potent biomarker for monitoring of disease severity in patients with Covid-19 and its correlation with Liver Enzymes and Lactate Dehydrogenase

Objectives: Alpha 1-antitrypsin (A1AT) is a single-chain glycoprotein containing 394 amino acids. It is primarily synthesized in the liver as an acute phase protein. According to recent studies, the COVID-19 virus can infect host cells by binding to the ACE2 receptor via a membrane protein. On the other hand, A1AT has the potential to inhibit neutrophil elastase and prevent the entry of the virus into host cells. Consequently, A1AT can reduce the severity and duration of COVID-19 disease Methods: Thirty-one hospitalized COVID-19 patients with a positive PCR test and thirty healthy volunteers with a negative test as the control group were selected. Upon hospitalization, demographic and biochemical tests were conducted for both patients and controls. Serum A1AT levels in both groups were measured using nephelometry as the reference method. Liver enzymes and total protein were also determined using commercially available kits. Results: Serum A1AT levels in the patients were increased compared to the control group, and this increase was inversely proportional to the duration of hospitalization and the relative improvement for discharge. Additionally, this elevation was correlated with qualitative C-reactive protein (CRP) levels. Serum liver enzymes, ALP, and LDH in patients were significantly higher than in the controls (P<0.05), while serum total protein in patients was significantly lower than in the controls (P<0.05). Conclusion: These data belong to a homologous group and show a correlation between serum A1AT levels and the duration of hospitalization, as well as with qualitative CRP levels. Furthermore, the increase in A1AT is proportional to the levels of serum AST, ALT, total protein, ALP, and LDH, which may serve as an alarm for potential liver involvement in such a disease. Thus, monitoring the liver condition is warranted.