超过10%的危重症COVID-19患者存在抗I型干扰素自身抗体：一项前瞻性多中心研究。
Auto-antibodies against type I IFNs in > 10% of critically ill COVID-19 patients: a prospective multicentre study.
作者信息
Arrestier Romain, Bastard Paul, Belmondo Thibaut, Voiriot Guillaume, Urbina Tomas, Luyt Charles-Edouard, Gervais Adrian, Bizien Lucy, Segaux Lauriane, Ben Ahmed Mariem, Bellaïche Raphaël, Pham Taï, Ait-Hamou Zakaria, Roux Damien, Clere-Jehl Raphael, Azoulay Elie, Gaudry Stéphane, Mayaux Julien, Fage Nicolas, Ait-Oufella Hafid, Moncomble Elsa, Parfait Mélodie, Dorgham Karim, Gorochov Guy, Mekontso-Dessap Armand, Canoui-Poitrine Florence, Casanova Jean-Laurent, Hue Sophie, de Prost Nicolas
机构信息
Service de Médecine Intensive Réanimation, Service de Réanimation Médicale, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, 94010, Paris, Cedex, France.
Groupe de Recherche Clinique CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil, Créteil, 94010, Paris, Cedex, France.
出版信息
Ann Intensive Care. 2022 Dec 31;12(1):121. doi: 10.1186/s13613-022-01095-5.
BACKGROUND
Auto-antibodies (auto-Abs) neutralizing type I interferons (IFN) have been found in about 15% of critical cases COVID-19 pneumonia and less than 1% of mild or asymptomatic cases. Determining whether auto-Abs influence presentation and outcome of critically ill COVID-19 patients could lead to specific therapeutic interventions. Our objectives were to compare the severity at admission and the mortality of patients hospitalized for critical COVID-19 in ICU with versus without auto-Abs.
RESULTS
We conducted a prospective multicentre cohort study including patients admitted in 11 intensive care units (ICUs) from Great Paris area hospitals with proven SARS-CoV-2 infection and acute respiratory failure. 925 critically ill COVID-19 patients were included. Auto-Abs neutralizing type I IFN-α2, β and/or ω were found in 96 patients (10.3%). Demographics and comorbidities did not differ between patients with versus without auto-Abs. At ICU admission, Auto-Abs positive patients required a higher FiO (100% (70-100) vs. 90% (60-100), p = 0.01), but were not different in other characteristics. Mortality at day 28 was not different between patients with and without auto-Abs (18.7 vs. 23.7%, p = 0.279). In multivariable analysis, 28-day mortality was associated with age (adjusted odds ratio (aOR) = 1.06 [1.04-1.08], p < 0.001), SOFA score (aOR = 1.18 [1.12-1.23], p < 0.001) and immunosuppression (aOR = 1.82 [1.1-3.0], p = 0.02), but not with the presence of auto-Abs (aOR = 0.69 [0.38-1.26], p = 0.23).
CONCLUSIONS
In ICU patients, auto-Abs against type I IFNs were found in at least 10% of patients with critical COVID-19 pneumonia. They were not associated with day 28 mortality.
背景
在约15%的重症新型冠状病毒肺炎（COVID-19）病例中发现了中和I型干扰素（IFN）的自身抗体（自身抗体），而在轻症或无症状病例中这一比例不到1%。确定自身抗体是否会影响重症COVID-19患者的临床表现和预后可能会带来特定的治疗干预措施。我们的目标是比较入住重症监护病房（ICU）的重症COVID-19患者中有无自身抗体时的入院严重程度和死亡率。
结果
我们进行了一项前瞻性多中心队列研究，纳入了来自大巴黎地区医院11个重症监护病房（ICU）的确诊感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）且出现急性呼吸衰竭的患者。共纳入925例重症COVID-19患者。在96例患者（10.3%）中发现了中和I型干扰素α2、β和/或ω的自身抗体。有自身抗体和无自身抗体的患者在人口统计学和合并症方面没有差异。在ICU入院时，自身抗体阳性患者需要更高的吸氧浓度（FiO）（100%（70 - 100）对90%（60 - 100），p = 0.01），但在其他特征方面没有差异。有自身抗体和无自身抗体的患者在第28天的死亡率没有差异（18.7%对23.7%，p = 0.279）。在多变量分析中，28天死亡率与年龄（调整后的优势比（aOR）= 1.06 [1.04 - 1.08]，p < 0.001）、序贯器官衰竭评估（SOFA）评分（aOR = 1.18 [1.12 - 1.23]，p < 0.001）和免疫抑制（aOR = 1.82 [1.1 - 3.0]，p = 0.02）相关，但与自身抗体的存在无关（aOR = 0.69 [0.38 - 1.26]，p = 0.23）。
结论
在ICU患者中，至少10%的重症COVID-19肺炎患者存在针对I型干扰素的自身抗体。它们与第28天的死亡率无关。
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