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Longitudinal changes of inflammatory parameters and their correlation with disease severity and outcomes in patients
Zhilin Zeng1, Haijing Yu1, Huilong Chen1
1Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030, China.
Insights
High inflammation markers like interleukin-6 (IL-6) and lactate dehydrogenase (LDH) indicate severe COVID-19. Early declines in these markers suggest better outcomes for coronavirus disease 2019 patients.
Area of Science:
- Infectious Diseases
- Immunology
- Biochemistry
Background:
- Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, is a significant global health concern.
- The precise mechanisms driving COVID-19 pathogenesis are still under investigation.
- Understanding the link between systemic inflammation and disease severity is crucial for patient management.
Purpose of the Study:
- To investigate the correlation between systemic inflammation and the severity of COVID-19.
- To analyze the association of specific inflammatory markers with disease outcomes.
- To explore potential sex-based differences in immune responses to SARS-CoV-2 infection.
Main Methods:
- A retrospective study involving 317 COVID-19 patients categorized by disease severity (moderate, severe, critical).
- Comparison of baseline characteristics, laboratory findings, and treatments.
- Longitudinal monitoring of serum cytokines, lactate dehydrogenase (LDH), high-sensitivity C-reactive protein (hsCRP), and hsCRP/lymphocyte count ratio (hsCRP/L) in 68 patients.
Main Results:
- Critically ill patients exhibited significantly higher levels of inflammatory markers (IL-6, TNF-α, ferritin, LDH, hsCRP, etc.) within 24 hours of admission compared to moderate and severe cases.
- Levels of pro-inflammatory cytokines, LDH, hsCRP, and hsCRP/L decreased over time in survivors but remained elevated in non-survivors.
- Male patients generally presented with higher concentrations of several inflammatory markers compared to female patients.
- Elevated IL-6 (>50 pg/mL) and LDH (>400 U/L) on admission were independently associated with increased COVID-19 severity.
Conclusions:
- Exaggerated inflammatory responses early in COVID-19 correlate with disease severity.
- SARS-CoV-2 infection may trigger differential immune responses based on sex.
- Interleukin-6 (IL-6) and lactate dehydrogenase (LDH) serve as independent predictors of COVID-19 severity.
- A timely reduction in these inflammation markers may indicate a favorable prognosis.
Background:
Coronavirus disease 2019 (COVID-19) is a newly emerging infectious disease and rapidly escalating epidemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The pathogenesis of COVID-19 remains to be elucidated. We aimed to clarify correlation of systemic inflammation with disease severity and outcomes in COVID-19 patients.
Methods:
In this retrospective study, baseline characteristics, laboratory findings, and treatments were compared among 317 laboratory-confirmed COVID-19 patients with moderate, severe, or critically ill form of the disease. Moreover, the longitudinal changes of serum cytokines, lactate dehydrogenase (LDH), high-sensitivity C-reactive protein (hsCRP), and hsCRP to lymphocyte count ratio (hsCRP/L) as well as their associations with disease severity and outcomes were investigated in 68 COVID-19 patients.
Results:
Within 24 h of admission, the critically ill patients showed higher concentrations of inflammatory markers including serum soluble interleukin (IL)-2 receptor, IL-6, IL-8, IL-10, tumor necrosis factor alpha (TNF-α), ferritin, procalcitonin, LDH, hsCRP, and hsCRP/L than patients with severe or moderate disease. The severe cases displayed the similar response patterns when compared with moderate cases. The longitudinal assays showed the levels of pro-inflammatory cytokines, LDH, hsCRP, and hsCRP/L gradually declined within 10 days post admission in moderate, severe cases or those who survived. However, there was no significant reduction in cytokines, LDH, hsCRP, and hsCRP/L levels in critically ill or deceased patients throughout the course of illness. Compared with female patients, male cases showed higher serum concentrations of soluble IL-2R, IL-6, ferritin, procalcitonin, LDH, and hsCRP. Multivariate logistic regression analysis revealed that IL-6 > 50 pg/mL and LDH > 400 U/L on admission were independently associated with disease severity in patients with COVID-19.
Conclusion:
Exuberant inflammatory responses within 24 h of admission in patients with COVID-19 may correlate with disease severity. SARS-CoV-2 infection appears to elicit a sex-based differential immune response. IL-6 and LDH were independent predictive parameters for assessing the severity of COVID-19. An early decline of these inflammation markers may be associated with better outcomes.
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