Maaß Henrike, Ynga-Durand Mario, Milošević Marko, Krstanović Fran, Matešić Marina Pribanić, Žuža Iva, Jonjić Stipan, Brizić Ilija, Šustić Alan, Bloos Frank, Protić Alen, Čičin-Šain Luka
Department of Viral Immunology, Helmholtz Center for Infection Research, Braunschweig, Germany.
Centre for Individualized Infection Medicine (CiiM), a joint venture of Helmholtz Centre for Infection Research and Hannover Medical School, Hannover, Germany.
Sci Rep. 2024 Jun 13;14(1):13605. doi: 10.1038/s41598-024-64384-y.
The aim of this study was to characterize the systemic cytokine signature of critically ill COVID-19 patients in a high mortality setting aiming to identify biomarkers of severity, and to explore their associations with viral loads and clinical characteristics. We studied two COVID-19 critically ill patient cohorts from a referral centre located in Central Europe. The cohorts were recruited during the pre-alpha/alpha (November 2020 to April 2021) and delta (end of 2021) period respectively. We determined both the serum and bronchoalveolar SARS-CoV-2 viral load and identified the variant of concern (VoC) involved. Using a cytokine multiplex assay, we quantified systemic cytokine concentrations and analyzed their relationship with clinical findings, routine laboratory workup and pulmonary function data obtained during the ICU stay. Patients who did not survive had a significantly higher systemic and pulmonary viral load. Patients infected with the pre-alpha VoC showed a significantly lower viral load in comparison to those infected with the alpha- and delta-variants. Levels of systemic CTACK, M-CSF and IL-18 were significantly higher in non-survivors in comparison to survivors. CTACK correlated directly with APACHE II scores. We observed differences in lung compliance and the association between cytokine levels and pulmonary function, dependent on the VoC identified. An intra-cytokine analysis revealed a loss of correlation in the non-survival group in comparison to survivors in both cohorts. Critically ill COVID-19 patients exhibited a distinct systemic cytokine profile based on their survival outcomes. CTACK, M-CSF and IL-18 were identified as mortality-associated analytes independently of the VoC involved. The Intra-cytokine correlation analysis suggested the potential role of a dysregulated systemic network of inflammatory mediators in severe COVID-19 mortality.
本研究的目的是在高死亡率背景下,对重症 COVID-19 患者的全身细胞因子特征进行表征,以识别严重程度的生物标志物,并探索它们与病毒载量和临床特征的关联。我们研究了来自中欧一家转诊中心的两个 COVID-19 重症患者队列。这两个队列分别在 pre-alpha/alpha 时期(2020 年 11 月至 2021 年 4 月)和德尔塔时期(2021 年底)招募。我们测定了血清和支气管肺泡中的 SARS-CoV-2 病毒载量,并确定了所涉及的关注变体(VoC)。使用细胞因子多重检测法,我们量化了全身细胞因子浓度,并分析了它们与临床发现、常规实验室检查以及重症监护病房住院期间获得的肺功能数据之间的关系。未存活的患者全身和肺部病毒载量显著更高。与感染 alpha 和德尔塔变体的患者相比,感染 pre-alpha VoC 的患者病毒载量显著更低。与存活者相比,非存活者的全身 CTACK、M-CSF 和 IL-18 水平显著更高。CTACK 与急性生理与慢性健康状况评分系统(APACHE II)评分直接相关。我们观察到肺顺应性存在差异,且细胞因子水平与肺功能之间的关联取决于所确定的 VoC。细胞因子内分析显示,与两个队列中的存活者相比,非存活组的相关性丧失。重症 COVID-19 患者根据其生存结果表现出独特的全身细胞因子谱。CTACK、M-CSF 和 IL-18 被确定为与死亡率相关的分析物,与所涉及的 VoC 无关。细胞因子内相关性分析表明,炎症介质系统性网络失调在重症 COVID-19 死亡中可能发挥作用。
Front Med (Lausanne). 2024-2-27