Abstract
BACKGROUND: Although the initial surge of the COVID-19 pandemic has passed, identifying prognostic biomarkers remains critical for managing severe cases and preparing for future respiratory viral outbreaks. Asprosin, a metabolic hormone involved in energy homeostasis and inflammation, has been linked to cardiometabolic disorders, but its relationship with COVID-19 severity has not been fully elucidated. This prospective study aimed to investigate the association between serum asprosin levels, disease severity, and clinical outcomes in COVID-19 patients. METHODS: A total of 121 participants were enrolled, including 95 hospitalized patients with RT-PCR-confirmed COVID-19 and 26 PCR-negative controls. Patients were classified into mild, moderate, or severe pneumonia groups based on chest CT findings. Demographic, clinical, and laboratory parameters-including serum asprosin-were analyzed for differences between groups and correlations with disease severity. RESULTS: Serum asprosin levels were significantly higher in COVID-19 patients compared to controls (p < 0.001) and served as an independent predictor of COVID-19 positivity (OR = 2.13, p = 0.017). ROC analysis demonstrated strong diagnostic performance (AUC = 0.849, p < 0.001), with a cut-off of 4.71 ng/mL yielding 98.9% sensitivity and 69.2% specificity. COVID-19 patients also showed higher ferritin, CRP, and urea, and lower platelet and albumin levels (p < 0.001). Mortality was strongly associated with pneumonia severity (p < 0.001); low oxygen saturation and hypertension emerged as independent predictors of severity. Asprosin correlated positively with fibrinogen and negatively with comorbidity count. Patients with diabetes mellitus had significantly lower asprosin levels (p = 0.042), while no significant differences were observed according to mortality status. CONCLUSIONS: Elevated serum asprosin in COVID-19 patients suggests involvement in metabolic and inflammatory responses. Although unrelated to disease severity, it may aid diagnosis and reflect systemic stress. Larger multicenter studies are needed to confirm its biomarker and therapeutic potential. CLINICAL TRIAL NUMBER: Not applicable.