Cytokines and their relationship with the severity and prognosis of coronavirus disease 2019 (COVID-19): a retrospective cohort study.
Cytokines and their relationship with the severity and prognosis of coronavirus disease 2019 (COVID-19): a retrospective cohort study.
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DOI：
10.1136/bmjopen-2020-041471
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发表时间：
2020-11-30
期刊：
影响因子：
2.9
通讯作者：
He F
中科院分区：
文献类型：
--
作者：
Liu QQ;Cheng A;Wang Y;Li H;Hu L;Zhao X;Wang T;He F
阐明COVID-19患者血浆炎性细胞因子变化的特点及临床意义。回顾性、单中心队列研究。中国武汉同济医院。在308名确诊为COVID-19的患者中，138名患者死亡，170名患者康复出院。数据收集至2020年2月27日。使用数据收集表从电子病历中获得临床特征和实验室检查结果。白细胞介素2受体（IL-2 R）、IL-6、IL-8、IL-10和肿瘤坏死因子（TNF）升高的患者百分比随疾病严重程度增加而增加（所有患者p<0.0001）。死亡患者的IL-2 R（p<0.0001）、IL-6（p<0.0001）、IL-8（p=0.0001）、IL-10（p<0.0001）和TNF（p<0.0001）也比康复患者高2倍至20倍。此外，IL-6和IL-10在两个进展患者组中均增加：中度（p=0.0026）和重度（p<0.0001）。在多变量分析中，入院时较高水平的IL-2 R（OR 1.001，95% CI 1.000至1.002，p=0.031）和IL-6（OR 1.013，95% CI 1.003至1.024，p=0.015）与院内死亡几率增加相关，与其他协变量无关，包括疾病严重程度和淋巴细胞计数。促炎和抗炎细胞因子（包括IL-2 R、IL-6、IL-8、TNF和IL-10）的增加与COVID-19的严重程度和住院死亡率明显相关。因此，我们的研究表明，细胞因子在预测COVID-19的严重程度方面很有价值，并有助于区分重症患者和受影响较小的患者。
To delineate the characteristics and clinical significance of plasma inflammatory cytokines altered in COVID-19. Retrospective, single-centre cohort study. Tongji Hospital in Wuhan, China. Among a cohort of 308 patients with a diagnosis of COVID-19, 138 patients died while 170 patients recovered and were discharged from the hospital. The data were collected until 27 February 2020. Clinical characteristics and laboratory findings were obtained from electronic medical records using data collection forms. The percentage of patients with elevated interleukin 2 receptor (IL-2R), IL-6, IL-8, IL-10 and tumour necrosis factor (TNF) increased with severity of disease (p<0.0001 for all). IL-2R (p<0.0001), IL-6 (p<0.0001), IL-8 (p=0.0001), IL-10 (p<0.0001) and TNF (p<0.0001) were also twofold to 20-fold higher in patients who died compared with those who recovered. Also, IL-6 and IL-10 increased in both the progressive patient groups: moderate (p=0.0026) and severe (p<0.0001). In multivariate analysis, higher levels of IL-2R (OR 1.001, 95% CI 1.000 to 1.002, p=0.031) and IL-6 (OR 1.013, 95% CI 1.003 to 1.024, p=0.015) on admission were associated with increasing odds of in-hospital death, independent of other covariates, including severity of disease and lymphocyte count. Increased proinflammatory and anti-inflammatory cytokines, including IL-2R, IL-6, IL-8, TNF and IL-10, showed an obvious association with both COVID-19 severity and in-hospital mortality. Thus, our study indicates that cytokines are valuable in predicting the severity of COVID-19 and helps in distinguishing critically ill patients from the less affected ones.
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