Abstract
Coronavirus disease (COVID)-19, as a result of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, has been the direct cause of over 2.2 million deaths worldwide. A timely coordinated host-immune response represents the leading driver for restraining SARS-CoV-2 infection. Indeed, several studies have described dysregulated immunity as the crucial determinant for critical illness and the failure of viral control. Improved understanding and management of COVID-19 could greatly reduce the mortality and morbidity caused by SARS-CoV-2. One aspect of the immune response that has to date been understudied is whether lipid mediator production is dysregulated in critically ill patients. In the present study, plasma from COVID-19 patients with either severe disease and those that were critically ill was collected and lipid mediator profiles were determined using liquid chromatography tandem mass spectrometry. Results from these studies indicated that plasma concentrations of both pro-inflammatory and pro-resolving lipid mediator were reduced in critically ill patients when compared with those with severe disease. Furthermore, plasma concentrations of a select group of mediators that included the specialized pro-resolving mediators (SPM) Resolvin (Rv) D1 and RvE4 were diagnostic of disease severity. Interestingly, peripheral blood SPM concentrations were also linked with outcome in critically ill patients, where we observed reduced overall concentrations of these mediators in those patients that did not survive. Together the present findings establish a link between plasma lipid mediators and disease severity in patients with COVID-19 and indicate that plasma SPM concentrations may be linked with survival in these patients.
Highlights
MethodsBetween 16th March 2020 and 1st May 2020, 38 adult (age > 18 years) patients with confirmed SARS-CoV-2 infection by viral PCR were recruited from Beaumont Hospital for an observational cohort study with peripheral blood lipid mediator profiling and analysis of clinical outcomes
Acute Respiratory Distress Syndrome (ARDS) is a life-threatening consequence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection
Continuous variables are represented as median and categorical variables are represented as absolute numbers
Summary
Between 16th March 2020 and 1st May 2020, 38 adult (age > 18 years) patients with confirmed SARS-CoV-2 infection by viral PCR were recruited from Beaumont Hospital for an observational cohort study with peripheral blood lipid mediator profiling and analysis of clinical outcomes. Patients above 18 years of age were approached for informed consent to blood sampling by the research team if they met the criteria of a positive PCR result for SARS-CoV-2. The cohort included patients admitted to the wards and ICU with SARS-CoV-2 infection. The majority of patients were recruited within 72 h of a positive PCR result. Patients were catagorised into two main groups, critically ill and severe disease. Patients were categorised as critically ill if they required invasive mechanical ventilation in the ICU. Demographics, age, gender, BMI, PaO2/FiO2 ratio, Sequential Organ Failure Assessment Score, ddimers, ferritin, ICU length of stay and survival were recorded for the cohort
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