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This prospective cohort study evaluated the relationship between NETosis markers—citrullinated histones (Cit-H3), myeloperoxidase (MPO), and elastase—and COVID-19 severity. Serum levels were measured at admission in 99 hospitalized adults and 30 controls, with marker associations assessed across non-severe, severe, and critical categories.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/relationship-of-circulatory-markers-of-netosis-with-covid-19-severity-a-prospective-cohort-study/448927/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/relationship-of-circulatory-markers-of-netosis-with-covid-19-severity-a-prospective-cohort-study/448927.png","ImageObject",300,407,{"name":92,"@type":93},"Putri","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-07","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":24},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What was the purpose of this study?","Question",{"text":112,"@type":113},"To assess the relationship between NETosis markers (Cit-H3, MPO, elastase) and COVID-19, including how these markers relate to disease severity.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How many participants were included, and how were samples handled?",{"text":117,"@type":113},"Ninety-nine hospitalized adults (18+ years) with COVID-19 and 30 controls were prospectively enrolled. Serum levels of Cit-H3, MPO, and elastase were measured at admission.",{"name":119,"@type":110,"acceptedAnswer":120},"Which NETosis marker showed the strongest signal for predicting COVID-19 severity?",{"text":121,"@type":113},"Cit-H3 significantly increased in severe cases versus the non-severe group and showed fair diagnostic ability for severity prediction, with sensitivity and specificity around 74% and 64% at a cut-off of 34 ng/mL.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},448927,1791215759,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":24,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":46},962085571259,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","ORIGINAL ARTICLE  \nRelationship of Circulatory Markers of NETosis with COVID-19 Severity: A Prospective Cohort Study  \nAbhyuday Kumar1, Neeraj Kumar2, Ayan Banerjee3, Ajeet Kumar4, Amarjeet Kumar5, Chandni Sinha6  \n Visual Abstract  \nReceived on: 10 June 2025; Accepted on: 21 November 2025; Published on: 19 December 2025  \nAbstrAct  \nBackground: NETosis is a unique form of cell death leading to the formation of neutrophil extracellular traps (NETs), which may be responsible for many of the serious complications of COVID-19, such as acute respiratory distress syndrome (ARDS), cytokine storm, thromboembolic complications, acute organ dysfunction, and multiorgan failure.  \nAims: The aim was to assess the relationship between markers of NETosis [citrullinated histones (Cit-H3), myeloperoxidase (MPO), and elastase] and COVID-19, as well as its severity.  \nPatients and methods: Ninety-nine hospitalized adult patients aged 18 years or older with COVID-19 and 30 controls were prospectively enrolled. Serum levels of Cit-H3, MPO, and elastase were measured atthe time of admission, and their levels were compared between the clinical categories ofCOVID-19 (non-severe, severe, and critical). The correlation between markers of NETosisand the PO2/FiO2 ratio was also determined. Results: Among the NETs markers, Cit-H3 and elastase levels significantly increased in the COVID-19 patients compared to the control. In the comparison of COVID-19 categories, only Cit-H3 significantly increased in severe categories compared to the non-severe group. Citrullinated histones showed fair diagnostic ability for the prediction of the severity, with a sensitivity and specificity of approximately 74 and 64%, respectively, at a cut-off of 34 ng/mL. Elastase was found to have a weak negative correlation, while Cit-H3 had a moderate negative correlation with the PO2/FiO2 ratio.  \nConclusions: Citrullinated histones, along with C-reactive protein (CRP), are independently associated with COVID-19 severity. These findings support the relevance of NETosis-related biomarkers in disease progression and may inform future research on targeted monitoring strategies. Clinical trial registration no: Clinical trial registry of India (CTRI/2020/10/028488) .  \nKeywords: Citrullinated histones, COVID-19, Elastase, Myeloperoxidase, NETosis.  \nIndian Journal of Critical Care Medicine (2025): 10.5005/jp-journals-10071-25103  \nHigHligHts  \n• NETosis maybe responsible for many of the serious complications ofCOVID-19, such as acute respiratory distress syndrome (ARDS), cytokine storm, thromboembolic complications, acute organ dysfunction, and multiorgan failure.  \n• Citrullinated histones (Cit-H3) were significantly increased in severe categories compared to the non-severe group.  \n• Cit-H3 showed fair diagnostic ability for the prediction of the severity, with a sensitivity and specificity of approximately 74 and 64%, respectively.  \n• Increased Cit-H3 levels, associated with worsening clinical status, point to the role of NETosis in COVID-19 severity and may serve as a promising predictor of disease severity.  \nbAckground  \nThe COVID-19 is expected to become an endemic disease in future; however, this transition may take years. New COVID-19 variants will likely continue to emerge and impact the world in the coming years.1 In early 2025, COVID-19 subvariants LF. 7 and NB.1.8 caused a surge in cases in many Asian cities like Singapore and Hong Kong.2 As of June 2025, a new variant named “XFG” was on the rise in the Western Pacific region, the Region of the Americas, and the European Region.3 Research is ongoing to fully understand the mechanisms behind COVID-19 infection and develop targeted therapies.  \nNeutrophils play an essential role as the first line of innate immune defense. At the infection sites, these cells are the first to  \n1,2,4–6Department of Anesthesiology, All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India  \n3Department of Biochemistry, All India In","cbCaigGjHw1GtYG7","https://ap.wps.com/l/cbCaigGjHw1GtYG7","pdf",541546,"English","# Background\n# Aims\n# Patients and methods\n# Results\n# Conclusions","[{\"question\":\"What was the purpose of this study?\",\"answer\":\"To assess the relationship between NETosis markers (Cit-H3, MPO, elastase) and COVID-19, including how these markers relate to disease severity.\"},{\"question\":\"How many participants were included, and how were samples handled?\",\"answer\":\"Ninety-nine hospitalized adults (18+ years) with COVID-19 and 30 controls were prospectively enrolled. Serum levels of Cit-H3, MPO, and elastase were measured at admission.\"},{\"question\":\"Which NETosis marker showed the strongest signal for predicting COVID-19 severity?\",\"answer\":\"Cit-H3 significantly increased in severe cases versus the non-severe group and showed fair diagnostic ability for severity prediction, with sensitivity and specificity around 74% and 64% at a cut-off of 34 ng/mL.\"}]","Relationship of Circulatory Markers of NETosis with COVID-19 Severity - A Prospective Cohort Study | PDF",1790729019]