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Corticosteroid treatment in critically ill COVID-19 patients reduced C-reactive protein and fibrinogen but increased TNF-α. Biomarker kinetics may guide personalized immunomodulatory therapies.

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Area of Science:

  • Critical care medicine
  • Immunology
  • Infectious diseases

Background:

  • Corticosteroids are standard COVID-19 care but their impact on systemic immune response is understudied.
  • Investigating the effects of corticosteroids on inflammatory markers in critically ill COVID-19 patients.

Purpose of the Study:

  • To evaluate the effect of corticosteroid treatment on systemic immune-inflammatory markers in critically ill COVID-19 patients.
  • To determine the association between these markers and patient outcomes.

Main Methods:

  • Multicenter prospective cohort study of critically ill COVID-19 patients.
  • Collected C-reactive protein (CRP), lymphocyte counts, fibrinogen, and cytokine levels (IL-6, IL-10, TNF-α) before and during ICU stay.
  • Used propensity score matching to balance treatment groups and mixed models for analysis.

Main Results:

  • Corticosteroid treatment was associated with lower CRP, fibrinogen, and lymphocyte counts over ICU stay.
  • No significant difference in IL-6 or IL-10 levels, but higher TNF-α levels were observed in treated patients.
  • In treated patients, CRP and lymphocyte counts correlated with outcomes, unlike cytokine levels.

Conclusions:

  • Corticosteroids modulate the inflammatory signature in COVID-19, decreasing some markers while increasing TNF-α.
  • CRP and lymphocyte count kinetics are associated with outcomes in treated patients.
  • Further research into biomarker kinetics could personalize immunomodulatory treatments.