The careful monitoring of patients with mild/moderate
COVID-19 is of particular importance because of the rapid progression of complications associated with
COVID-19. For prognostic reasons and for the economic management of health care resources, additional
biomarkers need to be identified, and their monitoring can conceivably be performed in the early stages of the disease. In this retrospective cross-sectional study, we found that serum concentrations of high-mobility group box 1 (
HMGB1) and
heme oxygenase-1 (HO-1), at the time of hospital admission, could be useful
biomarkers for
COVID-19 management. The study included 160 randomly selected recovered patients with mild to moderate
COVID-19 on admission. Compared with healthy controls, serum
HMGB1 and HO-1 levels increased by 487.6 pg/mL versus 43.1 pg/mL and 1497.7 pg/mL versus 756.1 pg/mL, respectively. Serum HO-1 correlated significantly with serum
HMGB1, oxidative stress parameters (
malondialdehyde (MDA), the
phosphatidylcholine/
lysophosphatidylcholine ratio (PC/LPC), the ratio of reduced and oxidative
glutathione (GSH/
GSSG)), and anti-inflammatory
acute phase proteins (
ferritin,
haptoglobin). Increased
heme catabolism/
hemolysis were not detected. We hypothesize that the increase in HO-1 in the early phase of
COVID-19 disease is likely to have a survival benefit by providing protection against oxidative stress and
inflammation, whereas the level of
HMGB1 increase reflects the activity of the innate immune system and represents levels within which the disease can be kept under control.