Longitudinal changes of inflammatory parameters and their correlation with disease severity and outcomes in patients with COVID-19 from Wuhan, China
Longitudinal changes of inflammatory parameters and their correlation with disease severity and outcomes in patients with COVID-19 from Wuhan, China
复制标题
中国武汉 COVID-19 患者炎症参数的纵向变化及其与疾病严重程度和结果的相关性
DOI：
10.1186/s13054-020-03255-0
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发表时间：
2020-08-27
期刊：
影响因子：
15.1
通讯作者：
Wu, Di
中科院分区：
文献类型：
--
作者：
Zeng, Zhilin;Yu, Haijing;Wu, Di
研究背景2019冠状病毒病（Coronavirus disease 2019，COVID-19）是由严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）引起的一种新型传染病，疫情迅速升级。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。MethodsIn this retrospective study，基线特征，实验室检查结果和治疗方法在317例实验室确诊的COVID-19患者中进行了比较，这些患者患有中度，重度或危重形式的疾病。此外，对68例COVID-19患者的血清细胞因子、乳酸脱氢酶（LDH）、超敏C反应蛋白（hsCRP）和hsCRP/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预后的关系进行了研究。重症患者显示出较高浓度的炎性标志物，包括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水平高于重度或中度疾病患者。与中度病例相比，重度病例显示出相似的反应模式。纵向分析显示，促炎细胞因子，LDH，hsCRP和hsCRP/L水平在入院后10天内逐渐下降，在中，重度或那些幸存者。然而，在整个疾病过程中，危重或死亡患者的细胞因子、LDH、hsCRP和hsCRP/L水平没有显著降低。与女性患者相比，男性患者血清可溶性IL-2 R、IL-6、铁蛋白、降钙素原、LDH和hsCRP浓度较高。多因素Logistic回归分析显示，入院时IL-6 > 50 pg/mL和LDH > 400 U/L与COVID-19患者病情严重程度独立相关。结论COVID-19患者入院24 h内炎症反应可能与病情严重程度相关。SARS-CoV-2感染似乎引起基于性别的差异性免疫应答。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果有关。
BackgroundCoronavirus 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.MethodsIn 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.ResultsWithin 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.ConclusionExuberant 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.