Comparative immune profiling of acute respiratory distress syndrome patients with or without SARS-CoV-2 infection

Acute respiratory distress syndrome (ARDS) is the main complication of coronavirus disease 2019 (COVID-19), requiring admission to the intensive care unit (ICU). Despite extensive immune profiling of COVID-19 patients, to what extent COVID-19-associated ARDS differs from other causes of ARDS remains unknown. To address this question, here, we build 3 cohorts of patients categorized in COVID-19(−)ARDS(+), COVID-19(+)ARDS(+), and COVID-19(+)ARDS(−), and compare, by high-dimensional mass cytometry, their immune landscape. A cell signature associating S100A9/calprotectin-producing CD169(+) monocytes, plasmablasts, and Th1 cells is found in COVID-19(+)ARDS(+), unlike COVID-19(−)ARDS(+) patients. Moreover, this signature is essentially shared with COVID-19(+)ARDS(−) patients, suggesting that severe COVID-19 patients, whether or not they experience ARDS, display similar immune profiles. We show an increase in CD14(+)HLA-DR(low) and CD14(low)CD16(+) monocytes correlating to the occurrence of adverse events during the ICU stay. We demonstrate that COVID-19-associated ARDS displays a specific immune profile and may benefit from personalized therapy in addition to standard ARDS management.