Lower C3 and C4 Complement Serum Levels Are Associated with More Severe Forms of COVID-19 Disease.

In a subgroup of patients, coronavirus disease (COVID)-19 is a severe illness with high mortality due to hyperinflammation, development of acute respiratory distress syndrome, and multiorgan dysfunction syndrome. Complement system activation plays a critical role in the pathogenesis and severity of COVID-19 disease. This cross-sectional, single-center study aimed to investigate the correlation between serum C3 and C4 levels and COVID-19 severity. We included 125 patients hospitalized between December 2020 and March 2021. Patients were stratified into three groups based on the level of respiratory support needed to maintain adequate oxygenation (PaO ≥ 60 mmHg): 51 patients requiring oxygen supplementation up to 15 L/min, 51 patients requiring high-flow oxygen therapy, and 23 patients requiring mechanical ventilation (MV). We analyzed the blood counts and serum levels of C3, C4, C-reactive protein (CRP), IL-6, procalcitonin, d-dimers, high-sensitive troponin I (TnI), N-terminal pro-brain natriuretic peptide (NT-proBNP), IgA, IgG, IgM, C3, C4, rheumatoid factor, and anticitrullinated peptide antibodies. Patients on MV had significantly lower levels of C3 and C4 (0.98 ± 0.24 g/L for C3 and 0.21 ± 013 g/L for C4) compared with patients with less severe disease ( < 0.001 for C3, < 0.001 for C4). Serum C3 and C4 levels were lower in patients requiring high-flow oxygen therapy than in those requiring oxygen supplementation, however, the difference was not statistically significant. In addition, higher neutrophil counts were observed in patients on MV or high-flow oxygen therapy than in those on oxygen supplementation, and higher CRP, procalcitonin, and NT-proBNP levels were observed only in patients on MV. The levels of IL-6, d-dimers, and high-sensitive TnI were positively correlated with disease severity, whereas lymphocyte counts showed a negative correlation, and these differences were statistically significant among all three groups. The determination of serum levels of C3 and C4, along with other known laboratory risk factors, may contribute to the detection of patients at an increased risk for severe COVID-19.