Elevated plasma IL-6 and CRP levels are associated with adverse clinical outcomes and death in critically ill SARS-CoV-2 patients: inflammatory response of SARS-CoV-2 patients.
Covid-19
Cytokine
Inflammation
Outcome
SARS-CoV-2
Journal
Annals of intensive care
ISSN: 2110-5820
Titre abrégé: Ann Intensive Care
Pays: Germany
ID NLM: 101562873
Informations de publication
Date de publication:
13 Jan 2021
13 Jan 2021
Historique:
received:
16
10
2020
accepted:
29
12
2020
entrez:
13
1
2021
pubmed:
14
1
2021
medline:
14
1
2021
Statut:
epublish
Résumé
SARS coronavirus 2 (SARS-CoV-2) is responsible for high morbidity and mortality worldwide, mostly due to the exacerbated inflammatory response observed in critically ill patients. However, little is known about the kinetics of the systemic immune response and its association with survival in SARS-CoV-2+ patients admitted in ICU. We aimed to compare the immuno-inflammatory features according to organ failure severity and in-ICU mortality. Six-week multicentre study (N = 3) including SARS-CoV-2+ patients admitted in ICU. Analysis of plasma biomarkers at days 0 and 3-4 according to organ failure worsening (increase in SOFA score) and 60-day mortality. 101 patients were included. Patients had severe respiratory diseases with PaO2/FiO2 of 155 [111-251] mmHg), SAPS II of 37 [31-45] and SOFA score of 4 [3-7]. Eighty-three patients (83%) required endotracheal intubation/mechanical ventilation and among them, 64% were treated with prone position. IL-1β was barely detectable. Baseline IL-6 levels positively correlated with organ failure severity. Baseline IL-6 and CRP levels were significantly higher in patients in the worsening group than in the non-worsening group (278 [70-622] vs. 71 [29-153] pg/mL, P < 0.01; and 178 [100-295] vs. 100 [37-213] mg/L, P < 0.05, respectively). Baseline IL-6 and CRP levels were significantly higher in non-survivors compared to survivors but fibrinogen levels and lymphocyte counts were not different between groups. After adjustment on SOFA score and time from symptom onset to first dosage, IL-6 and CRP remained significantly associated with mortality. IL-6 changes between Day 0 and Day 3-4 were not different according to the outcome. A contrario, kinetics of CRP and lymphocyte count were different between survivors and non-survivors. In SARS-CoV-2+ patients admitted in ICU, a systemic pro-inflammatory signature was associated with clinical worsening and 60-day mortality.
Sections du résumé
BACKGROUND
BACKGROUND
SARS coronavirus 2 (SARS-CoV-2) is responsible for high morbidity and mortality worldwide, mostly due to the exacerbated inflammatory response observed in critically ill patients. However, little is known about the kinetics of the systemic immune response and its association with survival in SARS-CoV-2+ patients admitted in ICU. We aimed to compare the immuno-inflammatory features according to organ failure severity and in-ICU mortality.
METHODS
METHODS
Six-week multicentre study (N = 3) including SARS-CoV-2+ patients admitted in ICU. Analysis of plasma biomarkers at days 0 and 3-4 according to organ failure worsening (increase in SOFA score) and 60-day mortality.
RESULTS
RESULTS
101 patients were included. Patients had severe respiratory diseases with PaO2/FiO2 of 155 [111-251] mmHg), SAPS II of 37 [31-45] and SOFA score of 4 [3-7]. Eighty-three patients (83%) required endotracheal intubation/mechanical ventilation and among them, 64% were treated with prone position. IL-1β was barely detectable. Baseline IL-6 levels positively correlated with organ failure severity. Baseline IL-6 and CRP levels were significantly higher in patients in the worsening group than in the non-worsening group (278 [70-622] vs. 71 [29-153] pg/mL, P < 0.01; and 178 [100-295] vs. 100 [37-213] mg/L, P < 0.05, respectively). Baseline IL-6 and CRP levels were significantly higher in non-survivors compared to survivors but fibrinogen levels and lymphocyte counts were not different between groups. After adjustment on SOFA score and time from symptom onset to first dosage, IL-6 and CRP remained significantly associated with mortality. IL-6 changes between Day 0 and Day 3-4 were not different according to the outcome. A contrario, kinetics of CRP and lymphocyte count were different between survivors and non-survivors.
CONCLUSIONS
CONCLUSIONS
In SARS-CoV-2+ patients admitted in ICU, a systemic pro-inflammatory signature was associated with clinical worsening and 60-day mortality.
Identifiants
pubmed: 33439360
doi: 10.1186/s13613-020-00798-x
pii: 10.1186/s13613-020-00798-x
pmc: PMC7804215
doi:
Types de publication
Journal Article
Langues
eng
Pagination
9Commentaires et corrections
Type : ErratumIn
Références
JAMA. 2020 Mar 17;323(11):1061-1069
pubmed: 32031570
N Engl J Med. 2012 Nov 8;367(19):1814-20
pubmed: 23075143
J Allergy Clin Immunol. 2020 Oct;146(4):799-807.e9
pubmed: 32710975
N Engl J Med. 2003 May 15;348(20):1967-76
pubmed: 12690091
Proc Natl Acad Sci U S A. 2014 Apr 1;111(13):4970-5
pubmed: 24599590
JAMA. 2020 Apr 21;323(15):1488-1494
pubmed: 32125362
J Infect Dis. 2016 Mar 15;213(6):904-14
pubmed: 26203058
Circulation. 2003 Oct 21;108(16):1930-2
pubmed: 14530191
N Engl J Med. 1996 Jun 27;334(26):1697-702
pubmed: 8637514
J Clin Invest. 2020 May 1;130(5):2620-2629
pubmed: 32217835
Nature. 2020 Mar;579(7798):270-273
pubmed: 32015507
JAMA. 2020 Apr 28;323(16):1574-1581
pubmed: 32250385
Clin Diagn Lab Immunol. 2003 Sep;10(5):813-20
pubmed: 12965910
J Clin Virol. 2020 Jun;127:104380
pubmed: 32353761
Clin Exp Rheumatol. 2020 May-Jun;38(3):529-532
pubmed: 32359035
Cytokine. 1996 Dec;8(12):938-43
pubmed: 9050753
Blood. 2019 Feb 7;133(6):511-520
pubmed: 30523120
Front Immunol. 2018 Apr 13;9:754
pubmed: 29706967
Vet Immunol Immunopathol. 2012 Apr 15;146(2):143-9
pubmed: 22424937
Int J Infect Dis. 2005 Nov;9(6):323-30
pubmed: 16095942
Thromb Res. 2020 Jul;191:9-14
pubmed: 32353746
Lancet. 2020 Feb 15;395(10223):497-506
pubmed: 31986264
J Med Virol. 2020 Nov;92(11):2283-2285
pubmed: 32343429
J Virol. 2010 Feb;84(3):1289-301
pubmed: 19906920
Lancet Respir Med. 2020 Dec;8(12):1233-1244
pubmed: 33075298
Intensive Care Med. 1999 Jul;25(7):686-96
pubmed: 10470572
Nat Rev Nephrol. 2017 Apr;13(4):241-257
pubmed: 28239173
JAMA. 1993 Dec 22-29;270(24):2957-63
pubmed: 8254858
Cell Host Microbe. 2020 Jun 10;27(6):992-1000.e3
pubmed: 32320677
Nat Med. 2020 Oct;26(10):1636-1643
pubmed: 32839624
Biochem J. 1997 Oct 15;327 ( Pt 2):425-9
pubmed: 9359411