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Abstract
Background: We sought to determine if there was a difference in the longitudinal inflammatory response measured by white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), and ferritin levels between the first and the second COVID-19 wave of ICU patients. Methods: In a single-center retrospective observational study, ICU patients were enrolled during the first and second waves of the COVID-19 pandemic. Data were collected on patient demographics, comorbidities, laboratory results, management strategies, and complications during the ICU stay. The inflammatory response was evaluated using WBC count, CRP, PCT, and Ferritin levels on the day of admission until Day 28, respectively. Organ dysfunction was measured by the SOFA score. Results: 65 patients were admitted during the first and 113 patients during the second wave. WBC and ferritin levels were higher in the second wave. CRP and PCT showed markedly different longitudinal kinetics up until day 28 of ICU stay between the first and second wave, with significantly lower levels in the second wave. Steroid and immunomodulatory therapy use was significantly greater in the second wave. Mortality was similar in both waves. Conclusions: We found that there was a significantly reduced inflammatory response in the second wave, which is likely to be attributable to the more widespread use of immunomodulatory therapies.
Highlights
A novel coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is responsible for the current global pandemic declared by the World Health Organisation (WHO) on 11th March 2020 [1]
Elevated levels of C-reactive protein (CRP) and Procalcitonin (PCT) have been associated with severe COVID-19, which suggests that these can be used as biomarkers for disease prognosis [5]
Sixty-five patients were admitted during the first wave and 113 patients were admitted during the second wave
Summary
A novel coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is responsible for the current global pandemic declared by the World Health Organisation (WHO) on 11th March 2020 [1]. Studies following the clinical course of COVID-19 established a strong connection between the severity of clinical presentation and inflammatory cell infiltration, as well as the amplification of cytokine release [4]. Elevated levels of C-reactive protein (CRP) and Procalcitonin (PCT) have been associated with severe COVID-19, which suggests that these can be used as biomarkers for disease prognosis [5]. Increased white blood cell count (WBC) has been established as being indicative of inflammation and has been associated with increased mortality in COVID-19 [6]. Ferritin synthesis can be stimulated by several inflammatory cytokines, including interleukin-6 (IL-6), which has been targeted in COVID19 [10]
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