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Published on: September 20, 2024
Longitudinal Cytokine Profile in Patients With Mild to Critical COVID-19
Lowell Ling1, Zigui Chen2, Grace Lui3,4
1Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.
Insights
Cytokine profiles in COVID-19 patients reveal key inflammatory markers like IL-8 and IP-10 that predict disease severity. Longitudinal analysis shows specific cytokines correlate with illness progression and clinical outcomes.
Area of Science:
- Immunology
- Infectious Diseases
- Critical Care Medicine
Background:
- Cytokine release syndrome is implicated in COVID-19 inflammation.
- Longitudinal cytokine profiles across COVID-19 severity spectrum are understudied.
Purpose of the Study:
- To compare early and late cytokine profiles in COVID-19 patients of varying severity.
- To identify cytokine associations with clinical endpoints in critically ill patients.
Main Methods:
- Prospective observational study of 40 adult COVID-19 patients.
- Blood samples analyzed for cytokine profiles in early (≤7 days) and late (8-12 days) phases.
- Patients categorized into mild, moderate, and severe/critical groups.
Main Results:
- 22 cytokines correlated with disease severity, including elevated Th1-related and ARDS-associated cytokines.
- IL-8, IP-10, and MDC identified as early biomarkers for predicting COVID-19 severity.
- Monocyte chemoattractant protein-1 (MCP-1) predicted mechanical ventilation duration and ICU stay in critical patients.
Conclusions:
- Cytokine profiles offer insights into COVID-19 pathogenesis and severity.
- Specific cytokines like IL-8, IP-10, and MCP-1 can serve as predictive biomarkers for disease progression and clinical outcomes.
Abstract:
The cytokine release syndrome has been proposed as the driver of inflammation in coronavirus disease 2019 (COVID-19). However, studies on longitudinal cytokine profiles in patients across the whole severity spectrum of COVID-19 are lacking. In this prospective observational study on adult COVID-19 patients admitted to two Hong Kong public hospitals, cytokine profiling was performed on blood samples taken during early phase (within 7 days of symptom onset) and late phase (8 to 12 days of symptom onset). The primary objective was to evaluate the difference in early and late cytokine profiles among patient groups with different disease severity. The secondary objective was to assess the associations between cytokines and clinical endpoints in critically ill patients. A total of 40 adult patients (mild = 8, moderate = 15, severe/critical = 17) hospitalized with COVID-19 were included in this study. We found 22 cytokines which were correlated with disease severity, as proinflammatory Th1-related cytokines (interleukin (IL)-18, interferon-induced protein-10 (IP-10), monokine-induced by gamma interferon (MIG), and IL-10) and ARDS-associated cytokines (IL-6, monocyte chemoattractant protein-1 (MCP-1), interleukin-1 receptor antagonist (IL-1RA), and IL-8) were progressively elevated with increasing disease severity. Furthermore, 11 cytokines were consistently different in both early and late phases, including seven (growth-regulated oncogene-alpha (GRO-α), IL-1RA, IL-6, IL-8, IL-10, IP-10, and MIG) that increased and four (FGF-2, IL-5, macrophage-derived chemokine (MDC), and MIP-1α) that decreased from mild to severe/critical patients. IL-8, followed by IP-10 and MDC were the best performing early biomarkers to predict disease severity. Among critically ill patients, MCP-1 predicted the duration of mechanical ventilation, highest norepinephrine dose administered, and length of intensive care stay.
