Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, China.
Crit Care. 2020 Aug 27;24(1):525. doi: 10.1186/s13054-020-03255-0.
Coronavirus disease 2019 (COVID-19) is a newly emerging infectious disease and rapidly escalating epidemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The pathogenesis of COVID-19 remains to be elucidated. We aimed to clarify correlation of systemic inflammation with disease severity and outcomes in COVID-19 patients.
In this retrospective study, baseline characteristics, laboratory findings, and treatments were compared among 317 laboratory-confirmed COVID-19 patients with moderate, severe, or critically ill form of the disease. Moreover, the longitudinal changes of serum cytokines, lactate dehydrogenase (LDH), high-sensitivity C-reactive protein (hsCRP), and hsCRP to lymphocyte count ratio (hsCRP/L) as well as their associations with disease severity and outcomes were investigated in 68 COVID-19 patients.
Within 24 h of admission, the critically ill patients showed higher concentrations of inflammatory markers including serum soluble interleukin (IL)-2 receptor, IL-6, IL-8, IL-10, tumor necrosis factor alpha (TNF-α), ferritin, procalcitonin, LDH, hsCRP, and hsCRP/L than patients with severe or moderate disease. The severe cases displayed the similar response patterns when compared with moderate cases. The longitudinal assays showed the levels of pro-inflammatory cytokines, LDH, hsCRP, and hsCRP/L gradually declined within 10 days post admission in moderate, severe cases or those who survived. However, there was no significant reduction in cytokines, LDH, hsCRP, and hsCRP/L levels in critically ill or deceased patients throughout the course of illness. Compared with female patients, male cases showed higher serum concentrations of soluble IL-2R, IL-6, ferritin, procalcitonin, LDH, and hsCRP. Multivariate logistic regression analysis revealed that IL-6 > 50 pg/mL and LDH > 400 U/L on admission were independently associated with disease severity in patients with COVID-19.
Exuberant inflammatory responses within 24 h of admission in patients with COVID-19 may correlate with disease severity. SARS-CoV-2 infection appears to elicit a sex-based differential immune response. IL-6 and LDH were independent predictive parameters for assessing the severity of COVID-19. An early decline of these inflammation markers may be associated with better outcomes.
新型冠状病毒病（COVID-19）是一种新出现的传染病和快速升级的流行病，由严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）引起。COVID-19 的发病机制仍有待阐明。我们旨在阐明 COVID-19 患者全身炎症与疾病严重程度和结局的相关性。
在这项回顾性研究中，我们比较了 317 例经实验室确诊的 COVID-19 患者中病情中度、重度或危重症患者的基线特征、实验室检查结果和治疗方法。此外，我们还在 68 例 COVID-19 患者中研究了血清细胞因子、乳酸脱氢酶（LDH）、高敏 C 反应蛋白（hsCRP）和 hsCRP 与淋巴细胞计数比值（hsCRP/L）的纵向变化及其与疾病严重程度和结局的关系。
在入院后 24 小时内，危重症患者的血清可溶性白细胞介素（IL）-2 受体、IL-6、IL-8、IL-10、肿瘤坏死因子-α（TNF-α）、铁蛋白、降钙素原、LDH、hsCRP 和 hsCRP/L 等炎症标志物的浓度均高于重症或中度疾病患者。与中度疾病患者相比，重度患者也表现出类似的反应模式。纵向检测显示，在中度、重度或存活患者入院后 10 天内，促炎细胞因子、LDH、hsCRP 和 hsCRP/L 水平逐渐下降。然而，在整个病程中，危重症或死亡患者的细胞因子、LDH、hsCRP 和 hsCRP/L 水平没有明显降低。与女性患者相比，男性患者的血清可溶性 IL-2R、IL-6、铁蛋白、降钙素原、LDH 和 hsCRP 浓度更高。多变量逻辑回归分析显示，入院时 IL-6>50pg/ml 和 LDH>400U/L 与 COVID-19 患者的疾病严重程度独立相关。
COVID-19 患者入院后 24 小时内过度的炎症反应可能与疾病严重程度相关。SARS-CoV-2 感染似乎引起了基于性别的不同免疫反应。IL-6 和 LDH 是评估 COVID-19 严重程度的独立预测参数。这些炎症标志物的早期下降可能与更好的结局相关。
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