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Low BALF CD4 T cells count is associated with extubation failure and mortality in critically ill covid-19 pneumonia

BACKGROUND: Critically ill COVID-19 pneumonia is one of the main causes of extubation failure and mortality. Understanding clinical characteristics, laboratory profiles and bronchoalveolar lavage fluid (BALF) immunopathology may help improve outcomes in critically ill COVID-19 pneumonia. We aimed to...

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Autores principales: Singh, Gurmeet, Martin Rumende, Cleopas, Sharma, Surendra K., Rengganis, Iris, Amin, Zulkifli, Loho, Tonny, Hermiyanti, Emmy, Harimurti, Kuntjoro, Wibowo, Heri
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Taylor & Francis 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9258432/
https://www.ncbi.nlm.nih.gov/pubmed/35786088
http://dx.doi.org/10.1080/07853890.2022.2095012
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author Singh, Gurmeet
Martin Rumende, Cleopas
Sharma, Surendra K.
Rengganis, Iris
Amin, Zulkifli
Loho, Tonny
Hermiyanti, Emmy
Harimurti, Kuntjoro
Wibowo, Heri
author_facet Singh, Gurmeet
Martin Rumende, Cleopas
Sharma, Surendra K.
Rengganis, Iris
Amin, Zulkifli
Loho, Tonny
Hermiyanti, Emmy
Harimurti, Kuntjoro
Wibowo, Heri
author_sort Singh, Gurmeet
collection PubMed
description BACKGROUND: Critically ill COVID-19 pneumonia is one of the main causes of extubation failure and mortality. Understanding clinical characteristics, laboratory profiles and bronchoalveolar lavage fluid (BALF) immunopathology may help improve outcomes in critically ill COVID-19 pneumonia. We aimed to describe clinical characteristics, laboratory profiles and BALF immunopathology based on lung severity in critically ill COVID-19 pneumonia patients. MATERIALS AND METHODS: Forty critically ill severe pneumonia patients requiring invasive mechanical ventilation in Cipto Mangunkusumo General (National Tertiary Referral Hospital), Indonesia within November 2020–January 2021 were enrolled in this study. Early BALF collection was performed after patients’ intubation. Clinical characteristics, laboratory profiles and BALF biomarkers (sTREM-1, alveolar macrophage amount and function, IL-6, IL-17, CD4 T-cells, Tregs, SP-A and Caspase-3) were observed and analysed. Outcomes were measured based on extubation failure (within 19 days) and 28-days mortality. Univariate and bivariate analyses were performed. RESULTS: Early bronchoscopy was performed in an average of 4 h (SD = 0.82) after patients’ intubation. Twenty-three and twenty-two patients had extubation failure (within 19 days) and 28-days mortality, respectively. In the baseline clinical characteristics of critically ill COVID-19 patients, we found no significant differences in the extubation and mortality status groups. In the laboratory profiles of critically ill COVID-19 patients, we found no significant differences in the extubation status groups. In critically ill COVID-19 pneumonia patients, there was a significant high D-dimer levels in survived group (p = .027), a significant low BALF CD4 T-cells count in the right lung (p = .001) and a significant low BALF CD4 T-cells count (p = .010 and p = .018) in severely affected lung with extubation failure and mortality. CONCLUSIONS: KEY MESSAGE: Few studies have been conducted during the peak COVID-19 period analysing combined bronchoalveolar lavage fluid (BALF) immunopathology biomarkers within four hours of intubation to assess extubation failure and mortality. In this study, we reported eight BALF immunopathology biomarkers (sTREM-1, alveolar macrophage, IL-6, IL-17, CD4 T-cells, Tregs, SP-A and Caspase-3). We found significantly low BALF CD4 T-cells count in the right lung, and low BALF CD4 T-cells count in severely affected lung of critically ill COVID-19 pneumonia patients in extubation failure and mortality.
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spelling pubmed-92584322022-07-07 Low BALF CD4 T cells count is associated with extubation failure and mortality in critically ill covid-19 pneumonia Singh, Gurmeet Martin Rumende, Cleopas Sharma, Surendra K. Rengganis, Iris Amin, Zulkifli Loho, Tonny Hermiyanti, Emmy Harimurti, Kuntjoro Wibowo, Heri Ann Med Infectious Diseases BACKGROUND: Critically ill COVID-19 pneumonia is one of the main causes of extubation failure and mortality. Understanding clinical characteristics, laboratory profiles and bronchoalveolar lavage fluid (BALF) immunopathology may help improve outcomes in critically ill COVID-19 pneumonia. We aimed to describe clinical characteristics, laboratory profiles and BALF immunopathology based on lung severity in critically ill COVID-19 pneumonia patients. MATERIALS AND METHODS: Forty critically ill severe pneumonia patients requiring invasive mechanical ventilation in Cipto Mangunkusumo General (National Tertiary Referral Hospital), Indonesia within November 2020–January 2021 were enrolled in this study. Early BALF collection was performed after patients’ intubation. Clinical characteristics, laboratory profiles and BALF biomarkers (sTREM-1, alveolar macrophage amount and function, IL-6, IL-17, CD4 T-cells, Tregs, SP-A and Caspase-3) were observed and analysed. Outcomes were measured based on extubation failure (within 19 days) and 28-days mortality. Univariate and bivariate analyses were performed. RESULTS: Early bronchoscopy was performed in an average of 4 h (SD = 0.82) after patients’ intubation. Twenty-three and twenty-two patients had extubation failure (within 19 days) and 28-days mortality, respectively. In the baseline clinical characteristics of critically ill COVID-19 patients, we found no significant differences in the extubation and mortality status groups. In the laboratory profiles of critically ill COVID-19 patients, we found no significant differences in the extubation status groups. In critically ill COVID-19 pneumonia patients, there was a significant high D-dimer levels in survived group (p = .027), a significant low BALF CD4 T-cells count in the right lung (p = .001) and a significant low BALF CD4 T-cells count (p = .010 and p = .018) in severely affected lung with extubation failure and mortality. CONCLUSIONS: KEY MESSAGE: Few studies have been conducted during the peak COVID-19 period analysing combined bronchoalveolar lavage fluid (BALF) immunopathology biomarkers within four hours of intubation to assess extubation failure and mortality. In this study, we reported eight BALF immunopathology biomarkers (sTREM-1, alveolar macrophage, IL-6, IL-17, CD4 T-cells, Tregs, SP-A and Caspase-3). We found significantly low BALF CD4 T-cells count in the right lung, and low BALF CD4 T-cells count in severely affected lung of critically ill COVID-19 pneumonia patients in extubation failure and mortality. Taylor & Francis 2022-07-04 /pmc/articles/PMC9258432/ /pubmed/35786088 http://dx.doi.org/10.1080/07853890.2022.2095012 Text en © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Infectious Diseases
Singh, Gurmeet
Martin Rumende, Cleopas
Sharma, Surendra K.
Rengganis, Iris
Amin, Zulkifli
Loho, Tonny
Hermiyanti, Emmy
Harimurti, Kuntjoro
Wibowo, Heri
Low BALF CD4 T cells count is associated with extubation failure and mortality in critically ill covid-19 pneumonia
title Low BALF CD4 T cells count is associated with extubation failure and mortality in critically ill covid-19 pneumonia
title_full Low BALF CD4 T cells count is associated with extubation failure and mortality in critically ill covid-19 pneumonia
title_fullStr Low BALF CD4 T cells count is associated with extubation failure and mortality in critically ill covid-19 pneumonia
title_full_unstemmed Low BALF CD4 T cells count is associated with extubation failure and mortality in critically ill covid-19 pneumonia
title_short Low BALF CD4 T cells count is associated with extubation failure and mortality in critically ill covid-19 pneumonia
title_sort low balf cd4 t cells count is associated with extubation failure and mortality in critically ill covid-19 pneumonia
topic Infectious Diseases
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9258432/
https://www.ncbi.nlm.nih.gov/pubmed/35786088
http://dx.doi.org/10.1080/07853890.2022.2095012
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