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Prognostic bioindicators in severe COVID-19 patients. Cytokine 2021; 141:155455. [PMID: 33548798 PMCID: PMC7843114 DOI: 10.1016/j.cyto.2021.155455] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 02/08/2023]
Abstract
Background Severe acute respiratory syndrome caused by novel coronavirus 2 (SARS-CoV-2) emerged in Wuhan (China) in December 2019. Here we evaluated a panel of biomarkers to phenotype patients and to define the role of immuno-inflammatory mediators as biomarkers of severity. Materials and methods Serum samples were obtained from 24 COVID-19 patients on admission to hospital, before any treatment or infusion of intravenous steroids or invasive ventilation. KL-6 IL-6 and C-peptide were measured by chemiluminescent enzyme immunoassay. IL-6 assay was validated for accuracy and precision. The validity of variables used to distinguish severe from mild-to-moderate patients was assessed by areas under curves (AUC) of the receiver operating characteristic (ROC) and logistic regression was performed to combine parameters of the two groups. Results In the severe group, IL-6, CRP and KL-6 concentrations were significantly higher than in mild-to-moderate patients. KL-6, IL-6 and CRP concentrations were directly correlated with each other. ROC curve analysis of the logistic regression model including IL-6, KL-6 and CRP showed the best performance with an AUC of 0.95. Conclusions Besides corroborating previous reports of over-expression of IL-6 in severe COVID-19 patients requiring mechanical ventilation, analytical determination of other mediators showed that IL-6 concentrations were correlated with those of KL-6 and CRP. The combination of these three prognostic bioindicators made it possible to distinguish severe COVID-19 patients with poor prognosis from mild-to-moderate patients.
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Benotmane I, Perrin P, Vargas GG, Bassand X, Keller N, Lavaux T, Ohana M, Bedo D, Baldacini C, Sagnard M, Bozman DF, Chiesa MD, Cognard N, Olagne J, Delagreverie H, Marx D, Heibel F, Braun L, Moulin B, Fafi-Kremer S, Caillard S. Biomarkers of Cytokine Release Syndrome Predict Disease Severity and Mortality From COVID-19 in Kidney Transplant Recipients. Transplantation 2021; 105:158-169. [PMID: 33009284 DOI: 10.1097/tp.0000000000003480] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Data on coronavirus disease 2019 (COVID-19) in immunocompromised kidney transplant recipients (KTR) remain scanty. Although markers of inflammation, cardiac injury, and coagulopathy have been previously associated with mortality in the general population of patients with COVID-19, their prognostic impact amongst KTR with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has not been specifically investigated. METHODS We conducted a cohort study of 49 KTR who presented with COVID-19. Clinical and laboratory risk factors for severe disease and mortality were prospectively collected and analyzed with respect to outcomes. The study participants were divided into 3 groups: (1) mild disease manageable in an outpatient setting (n = 8), (2) nonsevere disease requiring hospitalization (n = 21), and (3) severe disease (n = 20). RESULTS Gastrointestinal manifestations were common at diagnosis. The 30-day mortality rate in hospitalized patients was 19.5%. Early elevations of C-reactive protein (>100 mg/L) and interleukin-6 (>65 ng/L) followed by increases in high-sensitivity troponin I (>30 ng/L) and D-dimer (>960 ng/mL) were significantly associated with severe disease and mortality. Viral load did not have prognostic significance in our sample, suggesting that outcomes were chiefly driven by a cytokine release syndrome (CRS). CONCLUSIONS Regular monitoring of CRS biomarkers in KTR with COVID-19 is paramount to improve clinical outcomes.
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Affiliation(s)
- Ilies Benotmane
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
- Department of Virology, Strasbourg University Hospital, Strasbourg, France
- INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France
| | - Peggy Perrin
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
- INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France
| | | | - Xavier Bassand
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
| | - Nicolas Keller
- Department of Nephrology and Dialysis, University Hospital, Strasbourg, France
| | - Thomas Lavaux
- Department of Biochemistry and Molecular Biology, University Hospital, Strasbourg, France
| | - Mickael Ohana
- Department of Radiology, University Hospital, Strasbourg, France
| | - Dimitri Bedo
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
| | - Clément Baldacini
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
| | - Mylene Sagnard
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
| | - Dogan-Firat Bozman
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
| | - Margaux Della Chiesa
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
| | - Noëlle Cognard
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
| | - Jérôme Olagne
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
| | | | - David Marx
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
| | - Françoise Heibel
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
| | - Laura Braun
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
| | - Bruno Moulin
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
- INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France
| | - Samira Fafi-Kremer
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
- INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France
| | - Sophie Caillard
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
- INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France
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Perrin P, Collongues N, Baloglu S, Bedo D, Bassand X, Lavaux T, Gautier-Vargas G, Keller N, Kremer S, Fafi-Kremer S, Moulin B, Benotmane I, Caillard S. Cytokine release syndrome-associated encephalopathy in patients with COVID-19. Eur J Neurol 2020; 28:248-258. [PMID: 32853434 PMCID: PMC7461405 DOI: 10.1111/ene.14491] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/18/2020] [Indexed: 12/17/2022]
Abstract
Background and purpose Neurological manifestations in coronavirus disease (COVID)‐2019 may adversely affect clinical outcomes. Severe COVID‐19 and uremia are risk factors for neurological complications. However, the lack of insight into their pathogenesis, particularly with respect to the role of the cytokine release syndrome (CRS), is currently hampering effective therapeutic interventions. The aims of this study were to describe the neurological manifestations of patients with COVID‐19 and to gain pathophysiological insights with respect to CRS. Methods In this longitudinal study, we performed extensive clinical, laboratory and imaging phenotyping in five patients admitted to our renal unit. Results Neurological presentation included confusion, tremor, cerebellar ataxia, behavioral alterations, aphasia, pyramidal syndrome, coma, cranial nerve palsy, dysautonomia, and central hypothyroidism. Notably, neurological disturbances were accompanied by laboratory evidence of CRS. Severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) was undetectable in the cerebrospinal fluid (CSF). Hyperalbuminorrachia and increased levels of the astroglial protein S100B were suggestive of blood−brain barrier (BBB) dysfunction. Brain magnetic resonance imaging findings comprised evidence of acute leukoencephalitis (n = 3, one of whom had a hemorrhagic form), cytotoxic edema mimicking ischaemic stroke (n = 1), or normal results (n = 2). Treatment with corticosteroids and/or intravenous immunoglobulins was attempted, resulting in rapid recovery from neurological disturbances in two cases. SARS‐CoV2 was undetectable in 88 of the 90 patients with COVID‐19 who underwent Reverse Transcription‐PCR testing of CSF. Conclusions Patients with COVID‐19 can develop neurological manifestations that share clinical, laboratory and imaging similarities with those of chimeric antigen receptor T‐cell‐related encephalopathy. The pathophysiological underpinnings appear to involve CRS, endothelial activation, BBB dysfunction, and immune‐mediated mechanisms.
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Affiliation(s)
- P Perrin
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France.,Fédération de Médecine Translationnelle (FMTS), Strasbourg, France.,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France
| | - N Collongues
- Fédération de Médecine Translationnelle (FMTS), Strasbourg, France.,Department of Neurology, University Hospital, Strasbourg, France.,Clinical Center for Investigation, INSERM U1434, Strasbourg, France
| | - S Baloglu
- Department of Neuroradiology, University Hospital, Strasbourg, France
| | - D Bedo
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
| | - X Bassand
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
| | - T Lavaux
- Department of Biochemistry and Molecular Biology, University Hospital, Strasbourg, France
| | - G Gautier-Vargas
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France
| | - N Keller
- Department of Nephrology and Dialysis, University Hospital, Strasbourg, France
| | - S Kremer
- Department of Neuroradiology, University Hospital, Strasbourg, France
| | - S Fafi-Kremer
- Fédération de Médecine Translationnelle (FMTS), Strasbourg, France.,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France.,Department of Virology, Strasbourg University Hospital, Strasbourg, France
| | - B Moulin
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France.,Fédération de Médecine Translationnelle (FMTS), Strasbourg, France.,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France
| | - I Benotmane
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France.,Fédération de Médecine Translationnelle (FMTS), Strasbourg, France.,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France.,Department of Virology, Strasbourg University Hospital, Strasbourg, France
| | - S Caillard
- Department of Nephrology and Transplantation, University Hospital, Strasbourg, France.,Fédération de Médecine Translationnelle (FMTS), Strasbourg, France.,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France
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Efficacy of baricitinib in treating rheumatoid arthritis: Modulatory effects on fibrotic and inflammatory biomarkers in a real-life setting. Int Immunopharmacol 2020; 86:106748. [PMID: 32645631 DOI: 10.1016/j.intimp.2020.106748] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/03/2020] [Accepted: 06/25/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Baricitinib is a JAK inhibitor that blocks intracellular signalling pathways of inflammatory cytokines recommended for Rheumatoid arthritis (RA) patients not responding to initial treatment. Among RA extrareticular features, interstitial lung involvement is primarly characterized by fibrotic evolution. The aim of the present study was to analyse the effects of baricitinib in a population of RA and RA-ILD patients in a real-life setting, describing any changes in lung function parameters, serum inflammatory biomarkers and fibrotic biomarkers after 6 months of treatment. MATERIALS AND METHODS 15 patients (median (IQR) 65 (55-66); 13% males and 74% smokers) treated with baricitinib were enrolled. 4 patients (27%) were classified as RA-ILD before baricitinib therapy. Our study is the first to evaluate adipokine levels in RA patients (including a small population with RA-ILD) after six months of baricitinib treatment with a novel multiplex method. RESULTS The modulatory effects of baricitinib on lipid mediators were associated with clinical and functional improvement, demonstrated by the significant increase in DLco and KCO percentages after six months of treatment. Baricitinib decreased the systemic inflammation by lowering expression of IL-6 and CRP and reducing ESR and serum concentrations of adiponectin. A significant reduction of KL-6 levels in RA-ILD patients after six months of baricitinib therapy reflects the stability of interstitial lung involvement in these patients. CONCLUSION Baricitinib was demonstrated to be a safe immune modulator that reduces the concentrations biomarkers of lung fibrosis and inflammation in RA patients, including a subgroup with interstitial lung involvement.
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