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Elevated plasma IL-6 and CRP levels are associated with adverse clinical outcomes and death in critically ill SARS-CoV-2 patients: inflammatory response of SARS-CoV-2 patients

BACKGROUND: SARS coronavirus 2 (SARS-CoV-2) is responsible for high morbidity and mortality worldwide, mostly due to the exacerbated inflammatory response observed in critically ill patients. However, little is known about the kinetics of the systemic immune response and its association with surviva...

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Autores principales: Lavillegrand, Jean-Rémi, Garnier, Marc, Spaeth, Agathe, Mario, Nathalie, Hariri, Geoffroy, Pilon, Antoine, Berti, Enora, Fieux, Fabienne, Thietart, Sara, Urbina, Tomas, Turpin, Matthieu, Darrivere, Lucie, Fartoukh, Muriel, Verdonk, Franck, Dumas, Guillaume, Tedgui, Alain, Guidet, Bertrand, Maury, Eric, Chantran, Yannick, Voiriot, Guillaume, Ait-Oufella, Hafid
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804215/
https://www.ncbi.nlm.nih.gov/pubmed/33439360
http://dx.doi.org/10.1186/s13613-020-00798-x
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author Lavillegrand, Jean-Rémi
Garnier, Marc
Spaeth, Agathe
Mario, Nathalie
Hariri, Geoffroy
Pilon, Antoine
Berti, Enora
Fieux, Fabienne
Thietart, Sara
Urbina, Tomas
Turpin, Matthieu
Darrivere, Lucie
Fartoukh, Muriel
Verdonk, Franck
Dumas, Guillaume
Tedgui, Alain
Guidet, Bertrand
Maury, Eric
Chantran, Yannick
Voiriot, Guillaume
Ait-Oufella, Hafid
author_facet Lavillegrand, Jean-Rémi
Garnier, Marc
Spaeth, Agathe
Mario, Nathalie
Hariri, Geoffroy
Pilon, Antoine
Berti, Enora
Fieux, Fabienne
Thietart, Sara
Urbina, Tomas
Turpin, Matthieu
Darrivere, Lucie
Fartoukh, Muriel
Verdonk, Franck
Dumas, Guillaume
Tedgui, Alain
Guidet, Bertrand
Maury, Eric
Chantran, Yannick
Voiriot, Guillaume
Ait-Oufella, Hafid
author_sort Lavillegrand, Jean-Rémi
collection PubMed
description BACKGROUND: SARS coronavirus 2 (SARS-CoV-2) is responsible for high morbidity and mortality worldwide, mostly due to the exacerbated inflammatory response observed in critically ill patients. However, little is known about the kinetics of the systemic immune response and its association with survival in SARS-CoV-2+ patients admitted in ICU. We aimed to compare the immuno-inflammatory features according to organ failure severity and in-ICU mortality. METHODS: Six-week multicentre study (N = 3) including SARS-CoV-2+ patients admitted in ICU. Analysis of plasma biomarkers at days 0 and 3–4 according to organ failure worsening (increase in SOFA score) and 60-day mortality. RESULTS: 101 patients were included. Patients had severe respiratory diseases with PaO2/FiO2 of 155 [111–251] mmHg), SAPS II of 37 [31–45] and SOFA score of 4 [3–7]. Eighty-three patients (83%) required endotracheal intubation/mechanical ventilation and among them, 64% were treated with prone position. IL-1β was barely detectable. Baseline IL-6 levels positively correlated with organ failure severity. Baseline IL-6 and CRP levels were significantly higher in patients in the worsening group than in the non-worsening group (278 [70–622] vs. 71 [29–153] pg/mL, P < 0.01; and 178 [100–295] vs. 100 [37–213] mg/L, P < 0.05, respectively). Baseline IL-6 and CRP levels were significantly higher in non-survivors compared to survivors but fibrinogen levels and lymphocyte counts were not different between groups. After adjustment on SOFA score and time from symptom onset to first dosage, IL-6 and CRP remained significantly associated with mortality. IL-6 changes between Day 0 and Day 3–4 were not different according to the outcome. A contrario, kinetics of CRP and lymphocyte count were different between survivors and non-survivors. CONCLUSIONS: In SARS-CoV-2+ patients admitted in ICU, a systemic pro-inflammatory signature was associated with clinical worsening and 60-day mortality.
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spelling pubmed-78042152021-01-13 Elevated plasma IL-6 and CRP levels are associated with adverse clinical outcomes and death in critically ill SARS-CoV-2 patients: inflammatory response of SARS-CoV-2 patients Lavillegrand, Jean-Rémi Garnier, Marc Spaeth, Agathe Mario, Nathalie Hariri, Geoffroy Pilon, Antoine Berti, Enora Fieux, Fabienne Thietart, Sara Urbina, Tomas Turpin, Matthieu Darrivere, Lucie Fartoukh, Muriel Verdonk, Franck Dumas, Guillaume Tedgui, Alain Guidet, Bertrand Maury, Eric Chantran, Yannick Voiriot, Guillaume Ait-Oufella, Hafid Ann Intensive Care Research BACKGROUND: SARS coronavirus 2 (SARS-CoV-2) is responsible for high morbidity and mortality worldwide, mostly due to the exacerbated inflammatory response observed in critically ill patients. However, little is known about the kinetics of the systemic immune response and its association with survival in SARS-CoV-2+ patients admitted in ICU. We aimed to compare the immuno-inflammatory features according to organ failure severity and in-ICU mortality. METHODS: Six-week multicentre study (N = 3) including SARS-CoV-2+ patients admitted in ICU. Analysis of plasma biomarkers at days 0 and 3–4 according to organ failure worsening (increase in SOFA score) and 60-day mortality. RESULTS: 101 patients were included. Patients had severe respiratory diseases with PaO2/FiO2 of 155 [111–251] mmHg), SAPS II of 37 [31–45] and SOFA score of 4 [3–7]. Eighty-three patients (83%) required endotracheal intubation/mechanical ventilation and among them, 64% were treated with prone position. IL-1β was barely detectable. Baseline IL-6 levels positively correlated with organ failure severity. Baseline IL-6 and CRP levels were significantly higher in patients in the worsening group than in the non-worsening group (278 [70–622] vs. 71 [29–153] pg/mL, P < 0.01; and 178 [100–295] vs. 100 [37–213] mg/L, P < 0.05, respectively). Baseline IL-6 and CRP levels were significantly higher in non-survivors compared to survivors but fibrinogen levels and lymphocyte counts were not different between groups. After adjustment on SOFA score and time from symptom onset to first dosage, IL-6 and CRP remained significantly associated with mortality. IL-6 changes between Day 0 and Day 3–4 were not different according to the outcome. A contrario, kinetics of CRP and lymphocyte count were different between survivors and non-survivors. CONCLUSIONS: In SARS-CoV-2+ patients admitted in ICU, a systemic pro-inflammatory signature was associated with clinical worsening and 60-day mortality. Springer International Publishing 2021-01-13 /pmc/articles/PMC7804215/ /pubmed/33439360 http://dx.doi.org/10.1186/s13613-020-00798-x Text en © The Author(s) 2021, corrected publication 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Research
Lavillegrand, Jean-Rémi
Garnier, Marc
Spaeth, Agathe
Mario, Nathalie
Hariri, Geoffroy
Pilon, Antoine
Berti, Enora
Fieux, Fabienne
Thietart, Sara
Urbina, Tomas
Turpin, Matthieu
Darrivere, Lucie
Fartoukh, Muriel
Verdonk, Franck
Dumas, Guillaume
Tedgui, Alain
Guidet, Bertrand
Maury, Eric
Chantran, Yannick
Voiriot, Guillaume
Ait-Oufella, Hafid
Elevated plasma IL-6 and CRP levels are associated with adverse clinical outcomes and death in critically ill SARS-CoV-2 patients: inflammatory response of SARS-CoV-2 patients
title Elevated plasma IL-6 and CRP levels are associated with adverse clinical outcomes and death in critically ill SARS-CoV-2 patients: inflammatory response of SARS-CoV-2 patients
title_full Elevated plasma IL-6 and CRP levels are associated with adverse clinical outcomes and death in critically ill SARS-CoV-2 patients: inflammatory response of SARS-CoV-2 patients
title_fullStr Elevated plasma IL-6 and CRP levels are associated with adverse clinical outcomes and death in critically ill SARS-CoV-2 patients: inflammatory response of SARS-CoV-2 patients
title_full_unstemmed Elevated plasma IL-6 and CRP levels are associated with adverse clinical outcomes and death in critically ill SARS-CoV-2 patients: inflammatory response of SARS-CoV-2 patients
title_short Elevated plasma IL-6 and CRP levels are associated with adverse clinical outcomes and death in critically ill SARS-CoV-2 patients: inflammatory response of SARS-CoV-2 patients
title_sort elevated plasma il-6 and crp levels are associated with adverse clinical outcomes and death in critically ill sars-cov-2 patients: inflammatory response of sars-cov-2 patients
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804215/
https://www.ncbi.nlm.nih.gov/pubmed/33439360
http://dx.doi.org/10.1186/s13613-020-00798-x
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