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Longitudinal Characterization of Cytokine Overproduction: A Case Report in Critically Ill COVID-19 Patients With Hyperinflammation in Bronchoalveolar Lavage

Objectives: The longitudinal characterization and risk of poor outcomes related to cytokine overproduction in critical coronavirus disease 2019 (COVID-19) patients with hyperinflammation in bronchoalveolar lavage requires further investigation. Methods: We enrolled two critically ill patients with c...

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Autores principales: Luo, Zhen, Zhu, Chengliang, Ruan, Zhihui, Cui, Xianghua, Shereen, Muhammad Adnan, Pan, Pan, Huang, Jingtao, Wang, Fubing, Su, Hanwen, Xia, Yuchen, Wu, Jianguo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8452914/
https://www.ncbi.nlm.nih.gov/pubmed/34557500
http://dx.doi.org/10.3389/fmed.2021.690523
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author Luo, Zhen
Zhu, Chengliang
Ruan, Zhihui
Cui, Xianghua
Shereen, Muhammad Adnan
Pan, Pan
Huang, Jingtao
Wang, Fubing
Su, Hanwen
Xia, Yuchen
Wu, Jianguo
author_facet Luo, Zhen
Zhu, Chengliang
Ruan, Zhihui
Cui, Xianghua
Shereen, Muhammad Adnan
Pan, Pan
Huang, Jingtao
Wang, Fubing
Su, Hanwen
Xia, Yuchen
Wu, Jianguo
author_sort Luo, Zhen
collection PubMed
description Objectives: The longitudinal characterization and risk of poor outcomes related to cytokine overproduction in critical coronavirus disease 2019 (COVID-19) patients with hyperinflammation in bronchoalveolar lavage requires further investigation. Methods: We enrolled two critically ill patients with comorbidities diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detected by RT-PCR during hospitalization. Clinical characteristics, longitudinal immunological, and biochemical parameters of each critical COVID-19 case were collected. Main Results: The clinical characteristics and laboratory results of each case demonstrated critical symptoms of COVID-19 with poor outcomes. Both nasopharyngeal swabs and bronchoalveolar lavage fluid (BALF) samples tested positive for SARS-CoV-2. Two patients received targeted treatments against pathogen infection and inflammation in addition to interventional therapies, except for Patient 2, who received an additional artificial liver system treatment. Hyperinflammation with a dominantly high level of IL-6 was observed in BALF samples from both critical cases with decreased T cell populations. High levels of cytokines and pathological parameters were successively maintained in Patient 1, but rapidly reduced at the late treatment stage in Patient 2. The outcome of Patient 1 is death, whereas the outcome of Patient 2 is recovery. Conclusions: This case report suggests that a high risk of poor outcomes was related to a heavily hyperinflammatory milieu in both the blood and lungs of critical COVID-19 patients. The artificial liver intervention on cytokines overproduction might be beneficial for the recovery of critical COVID-19 patients as a reliable therapy that can be coordinated with targeted treatments, which ought to be further tested in adequately designed and powered clinical trials.
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spelling pubmed-84529142021-09-22 Longitudinal Characterization of Cytokine Overproduction: A Case Report in Critically Ill COVID-19 Patients With Hyperinflammation in Bronchoalveolar Lavage Luo, Zhen Zhu, Chengliang Ruan, Zhihui Cui, Xianghua Shereen, Muhammad Adnan Pan, Pan Huang, Jingtao Wang, Fubing Su, Hanwen Xia, Yuchen Wu, Jianguo Front Med (Lausanne) Medicine Objectives: The longitudinal characterization and risk of poor outcomes related to cytokine overproduction in critical coronavirus disease 2019 (COVID-19) patients with hyperinflammation in bronchoalveolar lavage requires further investigation. Methods: We enrolled two critically ill patients with comorbidities diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detected by RT-PCR during hospitalization. Clinical characteristics, longitudinal immunological, and biochemical parameters of each critical COVID-19 case were collected. Main Results: The clinical characteristics and laboratory results of each case demonstrated critical symptoms of COVID-19 with poor outcomes. Both nasopharyngeal swabs and bronchoalveolar lavage fluid (BALF) samples tested positive for SARS-CoV-2. Two patients received targeted treatments against pathogen infection and inflammation in addition to interventional therapies, except for Patient 2, who received an additional artificial liver system treatment. Hyperinflammation with a dominantly high level of IL-6 was observed in BALF samples from both critical cases with decreased T cell populations. High levels of cytokines and pathological parameters were successively maintained in Patient 1, but rapidly reduced at the late treatment stage in Patient 2. The outcome of Patient 1 is death, whereas the outcome of Patient 2 is recovery. Conclusions: This case report suggests that a high risk of poor outcomes was related to a heavily hyperinflammatory milieu in both the blood and lungs of critical COVID-19 patients. The artificial liver intervention on cytokines overproduction might be beneficial for the recovery of critical COVID-19 patients as a reliable therapy that can be coordinated with targeted treatments, which ought to be further tested in adequately designed and powered clinical trials. Frontiers Media S.A. 2021-09-07 /pmc/articles/PMC8452914/ /pubmed/34557500 http://dx.doi.org/10.3389/fmed.2021.690523 Text en Copyright © 2021 Luo, Zhu, Ruan, Cui, Shereen, Pan, Huang, Wang, Su, Xia and Wu. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Luo, Zhen
Zhu, Chengliang
Ruan, Zhihui
Cui, Xianghua
Shereen, Muhammad Adnan
Pan, Pan
Huang, Jingtao
Wang, Fubing
Su, Hanwen
Xia, Yuchen
Wu, Jianguo
Longitudinal Characterization of Cytokine Overproduction: A Case Report in Critically Ill COVID-19 Patients With Hyperinflammation in Bronchoalveolar Lavage
title Longitudinal Characterization of Cytokine Overproduction: A Case Report in Critically Ill COVID-19 Patients With Hyperinflammation in Bronchoalveolar Lavage
title_full Longitudinal Characterization of Cytokine Overproduction: A Case Report in Critically Ill COVID-19 Patients With Hyperinflammation in Bronchoalveolar Lavage
title_fullStr Longitudinal Characterization of Cytokine Overproduction: A Case Report in Critically Ill COVID-19 Patients With Hyperinflammation in Bronchoalveolar Lavage
title_full_unstemmed Longitudinal Characterization of Cytokine Overproduction: A Case Report in Critically Ill COVID-19 Patients With Hyperinflammation in Bronchoalveolar Lavage
title_short Longitudinal Characterization of Cytokine Overproduction: A Case Report in Critically Ill COVID-19 Patients With Hyperinflammation in Bronchoalveolar Lavage
title_sort longitudinal characterization of cytokine overproduction: a case report in critically ill covid-19 patients with hyperinflammation in bronchoalveolar lavage
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8452914/
https://www.ncbi.nlm.nih.gov/pubmed/34557500
http://dx.doi.org/10.3389/fmed.2021.690523
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