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Tian W, Han Z, Shi D, Wang H, Tang H, Wu Z, Zhang Y, Cui L, Shen N, Zheng J, Chen Y. Indeterminate Result of Interferon-γ Release Assay-A Risk Factor of Mortality for COVID-19 and Non-COVID-19 Respiratory Infections. J Med Virol 2024; 96:e70058. [PMID: 39588785 PMCID: PMC11590174 DOI: 10.1002/jmv.70058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 09/28/2024] [Accepted: 10/29/2024] [Indexed: 11/27/2024]
Abstract
Toward the end of 2022, the cessation of China's "dynamic zero-COVID policy" had led to a notable outbreak of SARS-CoV-2 infections and a substantial number of severe cases and deaths were reported, which raised serious concerns. Concurrently, our study identified a significant increase in the incidence of indeterminate results from the Interferon-γ Release Assay (IGRA) among hospitalized patients during this period. Peripheral T cells from these individuals were unable to produce measurable levels of IFN-γ upon stimulation with the PHA mitogen. This indeterminate IGRA results emerged as a potential risk factor for increased mortality among severely affected elderly COVID-19 patients, contributing to an understanding of the observed excess mortality. The deep serum proteomic analysis elucidated a dysfunctional immune response and defect in cardiac function of those patients. A predictive panel including IGRA results significantly enhanced the accuracy of predicting mortality outcomes in COVID-19 cases (AUC = 0.9762). We also extended the relevance of indeterminate IGRA outcomes as a risk factor for mortality to elderly non-COVID-19 respiratory infections, providing valuable prognostic insights into this type of disease and informing targeted and effective therapeutic interventions for similar outbreaks in the future.
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Affiliation(s)
- Wenmin Tian
- Center for Precision Medicine Multi‐Omics Research, Institute of Advanced Clinical MedicinePeking UniversityBeijingChina
| | - Zhongyu Han
- Department of Laboratory MedicinePeking University Third HospitalBeijingChina
| | - Dongxue Shi
- Center for Precision Medicine Multi‐Omics Research, Institute of Advanced Clinical MedicinePeking UniversityBeijingChina
| | - Hongli Wang
- Center for Precision Medicine Multi‐Omics Research, Institute of Advanced Clinical MedicinePeking UniversityBeijingChina
| | - Haohao Tang
- Center for Precision Medicine Multi‐Omics Research, Institute of Advanced Clinical MedicinePeking UniversityBeijingChina
| | - Zhenchao Wu
- Department of Pulmonary and Critical Care MedicinePeking University Third HospitalBeijingChina
- Center for Infectious DiseasesPeking University Third HospitalBeijingChina
| | - Yinmei Zhang
- Department of Laboratory MedicinePeking University Third HospitalBeijingChina
| | - Liyan Cui
- Department of Laboratory MedicinePeking University Third HospitalBeijingChina
- Center for Infectious DiseasesPeking University Third HospitalBeijingChina
| | - Ning Shen
- Department of Pulmonary and Critical Care MedicinePeking University Third HospitalBeijingChina
- Center for Infectious DiseasesPeking University Third HospitalBeijingChina
| | - Jiajia Zheng
- Department of Laboratory MedicinePeking University Third HospitalBeijingChina
- Center for Infectious DiseasesPeking University Third HospitalBeijingChina
| | - Yang Chen
- Center for Precision Medicine Multi‐Omics Research, Institute of Advanced Clinical MedicinePeking UniversityBeijingChina
- Department of Biochemistry and BiophysicsSchool of Basic Medical Sciences, Peking University Health Science CenterBeijingChina
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Peng W, Deng R, Wu S, Zhao J, Fu J, Zhang Y, Chen W, Wang W. Increased rates of indeterminate results in QuantiFERON-TB gold in-tube during the COVID-19 epidemic in Hunan province, China. Diagn Microbiol Infect Dis 2024; 108:116131. [PMID: 37976555 DOI: 10.1016/j.diagmicrobio.2023.116131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/18/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
Increased rates of indeterminate QuantiFERON-TB Gold In-Tube (QFT-GIT) results have been reported since the COVID-19 epidemic in Hunan Province, China. The indeterminate result (ITR) rate of QFT increased from an average of 5.2% to 12.4%, paralleling the first COVID-19 pandemic wave in the region. QFT-GIT results of 243 hospitalized patients with COVID-19 from January 2022 to April 2023 at Xiangya Hospital of Central South University were analyzed. Of the 243 patients, 71 (29.2%) had ITRs due to reduced interferon-gamma production in the positive control. Multiple factors are associated with ITRs, such as disease severity, respiratory failure incidence, immunosuppressant use, and prognosis. Additionally, interferon-gamma (Mitogen-Nil) levels differed significantly depending upon disease severity, prognosis, immunosuppressant use, sepsis symptoms, respiratory failure, or hyperlipidemia. An abnormal increase in the ITR rate in the QFT was observed after the COVID-19 pandemic, and an optimal machine learning predictive model for indeterminate QFT results was established.
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Affiliation(s)
- Wanchan Peng
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China
| | - Rihui Deng
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Siyu Wu
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China
| | - Juan Zhao
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China
| | - Jinfang Fu
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China
| | - Yunli Zhang
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China
| | - Wei Chen
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China
| | - Wei Wang
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China.
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Ben Tekaya A, Jerbi A, Ben Sassi M, Mokaddem S, Mahmoud I, Dziri C, Abdelmoula L. Prevalence of indeterminate tuberculosis interferon-gamma release assays in COVID-19 patients: Systematic review and meta-analysis. Health Sci Rep 2023; 6:e1695. [PMID: 38130328 PMCID: PMC10733599 DOI: 10.1002/hsr2.1695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 12/23/2023] Open
Abstract
Background and Aims The reliability of interferon-gamma-release-assays (IGRAs) for tuberculosis (TB) testing in coronavirus disease 2019 (COVID-19) patients is unknown. This study aimed to systematically review the prevalence of indeterminate TB-IGRA following SARS-CoV-2 infection or vaccination and to review associated factors. Methods This systematic literature review was guided according to the PRISMA guidelines by searching PubMed, Scopus, Web of Science, Clinicalkey, and Cochrane Library. Studies reporting results of TB-IGRA tests (QuantiFERON [QFT]-TB, T-SPOT.TB) in COVID-19 patients or vaccines were included. The random effects model was used to assess the prevalence of indeterminate IGRA results. Heterogeneity was evaluated using the Τ 2 and 95% predictive interval. Results Of the 273 citations screened, 12 articles were included in the final analysis including a total of 2107 patients. The overall pooled effect size proportion of indeterminate QFT-TB results, estimated in eight studies using the QFT-TB Plus assay, was 0.26 (95% CI: 0.205-0.324, Τ 2 = 0.158). The mean true effect size was 0.26 (95% predictive interval: [0.110-0.500]). A subgroup analysis was not undertaken due to the small number of studies. Indeterminate QFT-TB rates were associated with COVID-19 severity, steroid treatment, inflammation-related parameters, neutrophilia, and lymphopenia. Conclusion Indeterminate QFT-TB results in COVID-19 patients occur in almost one-quarter of tests performed. Further studies are needed to assess associated factors.
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Affiliation(s)
- Aicha Ben Tekaya
- Department of Rheumatology, Charles Nicolle Hospital, Faculty of Medicine of TunisUniversity Tunis El ManarTunisTunisia
| | - Ameni Jerbi
- Immunology Department, Habib Bourguiba Hospital, Faculty of Medicine of SfaxUniversity of SfaxSfaxTunisia
| | - Mouna Ben Sassi
- Department of Clinical Pharmacology, National Center of Pharmacovigilance, Faculty of Medicine of TunisUniversity Tunis El ManarTunisTunisia
| | - Salma Mokaddem
- Physiology Department, Faculty of Medicine of TunisUniversity of Tunis el ManarTunisTunisia
| | - Ines Mahmoud
- Department of Rheumatology, Charles Nicolle Hospital, Faculty of Medicine of TunisUniversity Tunis El ManarTunisTunisia
| | - Chedli Dziri
- Honoris Medical Simulation Center, Faculty of Medicine of TunisUniversity of Tunis el ManarTunisTunisia
| | - Leila Abdelmoula
- Department of Rheumatology, Charles Nicolle Hospital, Faculty of Medicine of TunisUniversity Tunis El ManarTunisTunisia
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Di Lorenzo A, Campogiani L, Iannetta M, Iannazzo R, Imeneo A, Alessio G, D’Aquila V, Massa B, Fato I, Rindi LV, Malagnino V, Teti E, Andreoni M, Sarmati L. The Impact of Viral and Bacterial Co-Infections and Home Antibiotic Treatment in SARS-CoV-2 Hospitalized Patients at the Policlinico Tor Vergata Hospital, Rome, Italy. Antibiotics (Basel) 2023; 12:1348. [PMID: 37760645 PMCID: PMC10525365 DOI: 10.3390/antibiotics12091348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
Co-infections during COVID-19 may worsen patients' outcomes. This study reports the results of a screening assessing the presence of co-infections among patients hospitalized for SARS-CoV-2 infection in the Infectious Diseases-Ward of the Policlinico Tor Vergata Hospital, Rome, Italy, from 1 January to 31 December 2021. Data on hepatitis B and C virus, urinary antigens for legionella pneumophila and streptococcus pneumoniae, pharyngeal swab for respiratory viruses, QuantiFERON®-TB Gold Plus assay (QFT-P), blood cultures and pre-hospitalization antibiotic prescription were recorded. A total of 482 patients were included, 61% males, median age of 65 years (IQR 52-77), median Charlson comorbidity index of 4 (IQR 2-5). The mortality rate was 12.4%; 366 patients needed oxygen supply. In total, 151 patients (31.3%) received home antibiotics without any association with the outcome. No significant association between mortality and the positivity of viral hepatitis markers was found. Out of 442 patients, 125 had an indeterminate QFT-P, associated with increased mortality. SARS-CoV-2 was the only respiratory virus detected among 389 pharyngeal swabs; 15/428 patients were positive for S. pneumoniae; none for L. pneumophila. In total, 237 blood cultures were drawn within 48 h from hospital admission: 28 were positive and associated with increased mortality. In our cohort, bacterial and viral co-infections in COVID-19 hospitalized patients were rare and not associated with higher mortality.
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Affiliation(s)
- Andrea Di Lorenzo
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
- Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Laura Campogiani
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
- Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Marco Iannetta
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
- Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Roberta Iannazzo
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
| | - Alessandra Imeneo
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
| | - Grazia Alessio
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
| | - Veronica D’Aquila
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
| | - Barbara Massa
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
| | - Ilenia Fato
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
| | - Lorenzo Vittorio Rindi
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
| | - Vincenzo Malagnino
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
- Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Elisabetta Teti
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
- Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Massimo Andreoni
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
- Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Loredana Sarmati
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
- Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy
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De Rose DU, Pace PG, Ceccherini-Silberstein F, Dotta A, Andreoni M, Sarmati L, Iannetta M. T Lymphocyte Subset Counts and Interferon-Gamma Production in Adults and Children with COVID-19: A Narrative Review. J Pers Med 2023; 13:jpm13050755. [PMID: 37240926 DOI: 10.3390/jpm13050755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Adults and children exhibit a broad range of clinical outcomes from SARS-CoV-2 infection, with minimal to mild symptoms, especially in the pediatric age. However, some children present with a severe hyperinflammatory post-infectious complication named multisystem inflammatory syndrome in children (MIS-C), mainly affecting previously healthy subjects. Understanding these differences is still an ongoing challenge, that can lead to new therapeutic strategies and avoid unfavorable outcomes. In this review, we discuss the different roles of T lymphocyte subsets and interferon-γ (IFN-γ) in the immune responses of adults and children. Lymphopenia can influence these responses and represent a good predictor for the outcome, as reported by most authors. The increased IFN-γ response exhibited by children could be the starting point for the activation of a broad response that leads to MIS-C, with a significantly higher risk than in adults, although a single IFN signature has not been identified. Multicenter studies with large cohorts in both age groups are still needed to study SARS-CoV-2 pathogenesis with new tools and to understand how is possible to better modulate immune responses.
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Affiliation(s)
- Domenico Umberto De Rose
- Neonatal Intensive Care Unit, "Bambino Gesù" Children's Hospital IRCCS, 00165 Rome, Italy
- PhD Course in Microbiology, Immunology, Infectious Diseases, and Transplants (MIMIT), Faculty of Medicine and Surgery, "Tor Vergata" University of Rome, 00133 Rome, Italy
| | - Pier Giorgio Pace
- Infectious Disease Unit, Department of System Medicine, "Tor Vergata" University and Hospital, 00133 Rome, Italy
| | | | - Andrea Dotta
- Neonatal Intensive Care Unit, "Bambino Gesù" Children's Hospital IRCCS, 00165 Rome, Italy
| | - Massimo Andreoni
- Infectious Disease Unit, Department of System Medicine, "Tor Vergata" University and Hospital, 00133 Rome, Italy
| | - Loredana Sarmati
- Infectious Disease Unit, Department of System Medicine, "Tor Vergata" University and Hospital, 00133 Rome, Italy
| | - Marco Iannetta
- Infectious Disease Unit, Department of System Medicine, "Tor Vergata" University and Hospital, 00133 Rome, Italy
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Alessio G, Imeneo A, Di Lorenzo A, Rossi B, Sorace C, Compagno M, Coppola L, Campogiani L, Crea AMA, Malagnino V, Buccisano F, Andreoni M, Sarmati L, Iannetta M. Longitudinal Evaluation of the QuantiFERON-TB Gold Plus Assay in Hospitalized COVID-19 Patients with a First Indeterminate Result: Resolution of Inflammation and Restoration of T-Lymphocyte Counts and Interferon-Gamma Production. Microbiol Spectr 2022; 10:e0185822. [PMID: 36098523 PMCID: PMC9602342 DOI: 10.1128/spectrum.01858-22] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Grazia Alessio
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | | | | | - Benedetta Rossi
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Chiara Sorace
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Mirko Compagno
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Luigi Coppola
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Laura Campogiani
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | | | | | - Francesco Buccisano
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Massimo Andreoni
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Loredana Sarmati
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Marco Iannetta
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
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