Predictive markers related to local and systemic inflammation in severe COVID-19-associated ARDS: a prospective single-center analysis

Abstract

Background As the COVID-19 pandemic strains healthcare systems worldwide, finding predictive markers of severe courses remains urgent. Most research so far was limited to selective questions hindering general assumptions for short- and long-term outcome. Methods In this prospective single-center biomarker study, 47 blood- and 21 bronchoalveolar lavage (BAL) samples were collected from 47 COVID-19 intensive care unit (ICU) patients upon admission. Expression of inflammatory markers toll-like receptor 3 (TLR3), heme oxygenase-1 (HO-1), interleukin (IL)-6, IL-8, leukocyte counts, procalcitonin (PCT) and carboxyhemoglobin (CO-Hb) was compared to clinical course. Clinical assessment comprised acute local organ damage, acute systemic damage, mortality and outcome after 6 months. Results PCT correlated with acute systemic damage and was the best predictor for quality of life (QoL) after 6 months (r = − 0.4647, p = 0.0338). Systemic TLR3 negatively correlated with impaired lung function (ECMO/ECLS: r = − 0.3810, p = 0.0107) and neurological short- (RASS mean: r = 0.4474, p = 0.0023) and long-term outcome (mRS after 6 m: r = − 0.3184, p = 0.0352). Systemic IL-8 correlated with impaired lung function (ECMO/ECLS: r = 0.3784, p = 0.0161) and neurological involvement (RASS mean: r = − 0.5132, p = 0.0007). IL-6 in BAL correlated better to the clinical course than systemic IL-6. Using three multivariate regression models, we describe prediction models for local and systemic damage as well as QoL. CO-Hb mean and max were associated with higher mortality. Conclusions Our predictive models using the combination of Charlson Comorbidity Index, sex, procalcitonin, systemic TLR3 expression and IL-6 and IL-8 in BAL were able to describe a broad range of clinically relevant outcomes in patients with severe COVID-19-associated ARDS. Using these models might proof useful in risk stratification and predicting disease course in the future. Trial registration The trial was registered with the German Clinical Trials Register (Trial-ID DRKS00021522, registered 22/04/2020).

Association between inflammation and post‐intensive care syndrome: a systematic review

“…In the primary analysis, 47 biomarkers were sampled in the 23 included studies. The most commonly sampled biomarkers were interleukin (IL)-6 (13 studies) [16,19,21,25,27,28,31,32,34,35,37,38,41]; C-reactive protein (CRP; 13 studies) [14, 15, 19-21, 25, 27, 30, 34, 40, 41, 43, 44]; IL-8 (seven studies) [19,21,27,28,31,35,41]; IL-1b (five studies) [19,27,34,35,41]; IL-10 (five studies) [19,21,32,35,41]; and procalcitonin (six studies) [23,25,30,31,38,41]. A complete list of the biomarkers sampled is available in online Supporting Information Appendix S2.…”

“…The global outcome measures used in these studies could be generally subdivided into measures of disability or function, and measures of quality of life. Eight studies showed association between inflammation and measures of disability or function [16,19,21,23,25,30,31,38]. Three studies found associations between inflammation and quality of life outcomes [31,37,40].…”

“…Eight studies showed association between inflammation and measures of disability or function [16,19,21,23,25,30,31,38]. Three studies found associations between inflammation and quality of life outcomes [31,37,40].…”

Multisystem Inflammatory Syndrome in an Adult on Hemodialysis with Markedly Elevated Procalcitonin and Ferritin Levels

“…Both this previous case and our patient had markedly elevated ferritin levels and were severely ill. The PCT level may be a predictive marker in patients with severe acute respiratory distress syndrome caused by COVID-19 ( 18 ). Therefore, the levels of these inflammatory markers may also be related to the severity of MIS-A.…”

Stratification of COVID-19 Patients with Moderate-to-Severe Hypoxemic Respiratory Failure for Response to High-Flow Nasal Cannula: A Retrospective Observational Study

“…Coronavirus disease 2019 (COVID- 19) is an infectious disease induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1] with heterogeneous clinical manifestations, ranging from asymptomatic infection to severe forms of respiratory failure defined as acute respiratory distress syndrome (ARDS) in about 15% of the cases [2][3][4][5][6][7][8].…”