Abstract
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.
Highlights
Two coronaviruses, including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) have been known to cause fatal pneumonia outbreak in the past two decades [1, 2]
Exuberant inflammatory responses within 24 h of admission in patients with COVID-19 may correlate with disease severity
Baseline laboratory findings, and treatments of COVID-19 patients Three hundred seventeen adult patients were enrolled in this retrospective study, and serum inflammatory parameters levels were measured within 24 h of admission
Summary
Two coronaviruses, including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) have been known to cause fatal pneumonia outbreak in the past two decades [1, 2]. Evidence has proven that COVID-19-related lung injury and extra-pulmonary organ dysfunction include acute respiratory distress syndrome (ARDS) like presentation, cardiac injury, kidney injury, liver injury, and sepsis as well as coagulation disorders [3, 8,9,10, 14, 15]. Those results gave credence to the view that SARS-CoV-2 infection was a pulmonary disease and a systemic inflammatory illness. We aimed to clarify correlation of systemic inflammation with disease severity and outcomes in COVID-19 patients
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