Serial change of neutrophil extracellular traps in tracheal aspirate of patients with acute respiratory distress syndrome: report of three cases

Ojima, Masahiro; Yamamoto, Naoki; Hirose, Tomoya; Hamaguchi, Shigeto; Tasaki, Osamu; Kojima, Takashi; Tomono, Kazunori; Ogura, Hiroshi; Shimazu, Takeshi

doi:10.1186/s40560-020-00444-5

Cited by 16 publications

(17 citation statements)

References 22 publications

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“…Activated neutrophils produce large quantities of S100A1 and A2, HMGB1 and free radicals. Furthermore, neutrophils release fibrous scaffolds containing DNA, histones, neutrophil elastase and myeloperoxidase that trap and kill pathogens, but also contribute to the development of acute respiratory distress syndrome 6,7 . To support their role, elevated neutrophil products have been identified in the sera of COVID-19 patients that correlate with clinical parameters such as C-reactive protein, D-dimer, and lactate dehydrogenase 8 .…”

Section: Discussionmentioning

confidence: 99%

Longitudinal immune profiling reveals distinct features of COVID-19 pathogenesis

Mann

Menon

Knight

et al. 2020

Preprint

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Background The pathogenesis of COVID-19, caused by a novel strain of coronavirus (SARS-CoV-2), involves a complex host-virus interaction and is characterised by an exaggerated immune response, the specific components of which are poorly understood. Here we report the outcome of a longitudinal immune profiling study in hospitalised patients during the peak of the COVID-19 pandemic in the UK and show the relationship between immune responses and severity of the clinical presentation. Methods The Coronavirus Immune Response and Clinical Outcomes (CIRCO) study was conducted at four hospitals in Greater Manchester. Patients with SARS-CoV-2 infection, recruited as close to admission as possible, provided peripheral blood samples at enrolment and sequentially thereafter. Fresh samples were assessed for immune cells and proteins in whole blood and serum. Some samples were also stimulated for 3 hours with LPS and analysed for intracellular proteins. Results were stratified based on patient-level data including severity of symptoms and date of reported symptom onset. Findings Longitudinal analysis showed a very high neutrophil to T cell ratio and abnormal activation of monocytes in the blood, which displayed high levels of the cell cycle marker, Ki67 and low COX-2. These properties all reverted in patient with good outcome. Unexpectedly, multiple aspects of inflammation were diminished as patients progressed in severity and time, even in ITU patients not recovering. Interpretation This is the first detailed longitudinal analysis of COVID-19 patients of varying severity and outcome, revealing common features and aspects that track with severity. Patients destined for a severe outcome can be identified at admission when still displaying mild-moderate symptoms. We provide clues concerning pathogenesis that should influence clinical trials and therapeutics. Targeting pathways involved in neutrophil and monocyte release from the bone marrow should be tested in patients with COVID-19. Funding: The Kennedy Trust for Rheumatology Research, The Wellcome Trust, The Royal Society, The BBSRC, National Institute for Health Research (NIHR) Biomedical Research Centres (BRC).

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Section: Discussionmentioning

confidence: 99%

Longitudinal immune profiling reveals distinct features of COVID-19 pathogenesis

Mann

Menon

Knight

et al. 2020

Preprint

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“…The literature showed that neutrophil counts are positively correlated with the degree of inflammation in ARDS (23). It has been reported that neutrophils and neutrophil-derived particles are significantly increased in bronchoalveolar lavage fluid of ARDS patients (24,25). Several studies have shown that during the occurrence of acute lung injury (ALI), neutrophils are the first immune cells to be recruited to inflammatory sites, after being stimulated by chemokines released from damaged lung tissue.…”

Section: Discussionmentioning

confidence: 99%

The Association Between the Baseline and the Change in Neutrophil-to-Lymphocyte Ratio and Short-Term Mortality in Patients With Acute Respiratory Distress Syndrome

Zhang

Wang²,

et al. 2021

Front. Med.

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Background: Two previous studies have shown that increased neutrophil to lymphocyte ratio (NLR) is associated with short-term prognosis in patients with acute respiratory distress syndrome (ARDS), but it is usually assessed as a single threshold value at baseline. We investigated the relationship between the baseline and the early change in NLR and 30-day mortality in patients with ARDS to evaluate the prognostic value of NLR baseline and NLR changes during the first 7 days after ICU admission.Methods: This is a retrospective cohort study, with all ARDS patients diagnosed according to the Berlin definition from the Medical Information Mart for Intensive Care III (MIMIC-III) database. We calculated the NLR by dividing the neutrophil count by the lymphocyte count. The multivariable logistic regression analysis was used to investigate the relationship between the baseline NLR and short-term mortality. Then the generalized additive mixed model was used to compare trends in NLR over time among survivors and non-survivors after adjusting for potential confounders.Results: A total of 1164 patients were enrolled in our study. Multivariable logistic regression analysis showed that after adjusting for confounders, elevated baseline NLR was a significant risk factor predicting 30-day mortality (OR 1.02, 95%CI 1.01, 1.03, P = 0.0046) and hospital mortality (OR 1.02, 95%CI 1.01, 1.03, P = 0.0003). The result of the generalized additive mixed model showed that the NLR decreased in the survival group and increased in the non-survival group gradually within 7 days after ICU admission. The difference between the two groups showed a trend of increase gradually and the difference increased by an average of 0.67 daily after adjusting for confounders.Conclusions: We confirmed that there was a positive correlation between baseline NLR and short-term mortality, and we found significant differences in NLR changes over time between the non-survival group and the survival group. The early increase in NLR was associated with short-term mortality in ARDS patients.

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“…[ 4 ] Thus, there exists a greatly elevated neutrophilia in severe cases of COVID-19 which contributes to the ARDS. [ 21 22 ]…”

Section: Discussionmentioning

confidence: 99%

Role of Hematological and Immunological Parameters in COVID-19 Patients

Kumar

Sepolia²,

Shilpa

et al. 2021

Journal of Pharmacy and Bioallied Sciences

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Background: The ongoing pandemic of coronavirus disease 2019 (COVID-19) which was caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to efforts from the medical and scientific community in understanding the biological basis of COVID-19 pathophysiological mechanisms. Thus, analysis of various hematological and immunological parameters may be helpful for COVID-19 infection evaluation for risks involved and effectiveness in management. Aim: The aim of this study was to analyze the role of various hematological and immunological parameters in patients infected with SARS-CoV-2. Materials and Methods: This retrospective analysis was performed on 300 patients who tested positive for SARS-CoV-2 by quantitative reverse transcription–polymerase chain reaction analysis. All participants of the study were divided into – (a) Group I: patients with mild symptoms and normal chest radiographic findings; (b) patients with moderate disease presenting with fever and cough along with other respiratory symptoms, and (c) patients suffering from severe disease. Data collection was done from all patients at the time of hospital admission for hematological and immunological parameters – (a) total leukocyte count, (b) lymphocyte count, (c) lymphocytic subset count, (d) lactate dehydrogenase (LDH) levels, (e) D-dimer, (f) C-reactive protein (CRP), and (g) ferritin levels. SPSS 22.0 software was used for determining P values by independent t-test and Chi-square test. Results: The median age was 65 years (interquartile range –57–71 years). While comparing white blood cell and lymphocyte counts, extremely significant P values were obtained. D-dimers and ferritin levels demonstrated extremely significant P values while both LDH and CRPs showed statistical significance. Correlation of lymphocytic subsets showed extreme significance in total lymphocyte counts in mild-to-moderate as compared to severely infected patients while both CD4+ and CD8+ counts demonstrated statistical significance in mild-moderate infected cases. Statistical significance was noted in D-dimer, CRP, and LDH levels also. Conclusion: Assessment of hematological and immunological parameters can be used to plan the management of COVID-19 patients.

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Serial change of neutrophil extracellular traps in tracheal aspirate of patients with acute respiratory distress syndrome: report of three cases

Cited by 16 publications

References 22 publications

Longitudinal immune profiling reveals distinct features of COVID-19 pathogenesis

Longitudinal immune profiling reveals distinct features of COVID-19 pathogenesis

The Association Between the Baseline and the Change in Neutrophil-to-Lymphocyte Ratio and Short-Term Mortality in Patients With Acute Respiratory Distress Syndrome

Role of Hematological and Immunological Parameters in COVID-19 Patients

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