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Trøseid M, Arribas JR, Assoumou L, Holten AR, Poissy J, Terzić V, Mazzaferri F, Baño JR, Eustace J, Hites M, Joannidis M, Paiva JA, Reuter J, Püntmann I, Patrick-Brown TDJH, Westerheim E, Nezvalova-Henriksen K, Beniguel L, Dahl TB, Bouscambert M, Halanova M, Péterfi Z, Tsiodras S, Rezek M, Briel M, Ünal S, Schlegel M, Ader F, Lacombe K, Amdal CD, Rodrigues S, Tonby K, Gaudet A, Heggelund L, Mootien J, Johannessen A, Møller JH, Pollan BD, Tveita AA, Kildal AB, Richard JC, Dalgard O, Simensen VC, Baldé A, de Gastines L, del Álamo M, Aydin B, Lund-Johansen F, Trabaud MA, Diallo A, Halvorsen B, Røttingen JA, Tacconelli E, Yazdanpanah Y, Olsen IC, Costagliola D, Dyrhol-Riise AM, Stiksrud B, Jenum S, MacPherson ME, Aarskog NR, Røstad K, Skeie LG, Dahl Å, Steen JK, Nur S, Segers F, Korsan KA, Sethupathy A, Sandstå AJ, Paulsen GJ, Ueland T, Michelsen A, Aukrust P, Berdal JE, Melkeraaen I, Tollefsen MM, Andreassen J, Dokken J, Müller KE, Woll BM, Opsand H, Bogen M, Rød LT, Steinsvik T, Åsheim-Hansen B, Bjerkreim RH, Berg Å, Moen S, Kvalheim S, Strand K, Gravrok B, Skogen V, Lorentzen EM, Schive SW, Rossvoll L, Hoel H, Engebråten S, Martinsson MS, Thallinger M, Ådnanes E, Hannula R, Bremnes N, Liyanarachi K, Ehrnström B, Kvalshaug M, Berge K, Bygdås M, Gustafsson L, AballiB S, Strand M, Andersen B, Aukrust P, Barratt-Due A, Henriksen KN, Kåsine T, Dyrhol-Riise AM, Berdal JE, Favory R, Nseir S, Preau S, Jourdain M, Ledoux G, Durand A, Houard M, Moreau AS, Rouzé A, Tortuyaux R, Degouy G, Levy C, Liu V, Dognon N, Mariller L, Delcourte C, Reguig Z, Cerf A, Cuvelliez M, Kipnis E, Boyer-Beysserre M, Bignon A, Parmentier L, Meddour D, Frade S, Timsit JF, Peiffer-Smadja N, Wicky PH, De Montmollin E, Bouadma L, Dessajan J, Sonneville R, Patrier J, Presente S, Sylia Z, Rioux C, Thy M, Collias L, Bouaraba Y, Dobremel N, Dureau AF, Oudeville P, Pointurier V, Rabouel Y, Stiel L, Alzina C, Ramstein C, Ait-Oufella H, Hamoudi F, Urbina T, Zerbib Y, Maizel J, Wilpotte C, Piroth L, Blot M, Sixt T, Moretto F, Charles C, Gohier S, Roux D, Le Breton C, Gernez C, Thiry I, Baboi L, Malvy D, Boyer A, Perreau P, Armellini M, De Luca G, Di Pietro OSMM, Romanin B, Brogi M, Castelli F, Amadasi S, Barchiesi F, Canovari B, Coppola N, Pisaturo M, Russo A, Occhiello L, Cataldo F, Rillo MM, Queiruga J, Seco E, Stewart S, Borobia AM, Moraga P, Prieto R, García I, Rivera C, Narro JL, Chacón N, de la Rosa S, Macías M, Barrera L, Serna A, Palomo V, Sánchez MIG, Gutiérrez D, Campos AS, Garfia MÁG, Toyos EB, Cabrera JS, Lucena MI, Lapique EL, Englert P, Khalil Z, Jacobs F, Malaise J, Mukangenzi O, Smissaert C, Hildebrand M, Martiny D, Vervacke A, Scarnière A, Yin N, Michel C, Seyler L, Allard S, Van Laethem J, Verschelden G, Meeuwissen A, De Waele A, Van Buggenhout V, Monteyne D, Noppe N, Belkhir L, Yombi JC, De Greef J, Mesland JB, De Ghellinck L, Kin V, D’Aoust C, Bouvier A, Dekeister AC, Hawia E, Gaillet A, Deshorme H, Halleux S, Galand V, Roncon-Albuquerque R, Santos LL, Vieira CB, Magalhaes R, Ferreira S, Bernardo M, Jackson A, Sadlier C, O’Connell S, Blair M, Manning E, Cusack F, Kelly N, Stephenson H, Keane R, Murphy A, Cunnane M, Keane F, O’Regan MC, de Barra E, Bellone AM, O’Regan S, Carey P, Harte J, Coakley P, Heeney A, Ryan D, Curley G, McConkey S, Sulaiman I, Costello R, McNally C, Foley C, Trainor S, Jacob B, Vengathodi S, Kent B, Bergin C, Townsend L, Kerr C, Panti N, Sanz AG, Benny B, Dea EO, Galvin N, Burke C, Galvin A, Aisiyabi S, Lobo D, Laffey J, McNicolas B, Cosgrave D, Sheehan JR, Nita C, Hanley C, Kelly C, Kernan M, Murray J, Staub T, Henin T, Damilot G, Bintener T, Colling J, Ferretti C, Werer C, Stammet P, Braquet P, Arendt V, Calvo E, Michaux C, Mediouni C, Znati A, Montanes G, Garcia L, Thomé C, Breitkopf R, Peer A, Lehner G, Bellman R, Ditlbacher A, Finkenstedt A, Zotter K, Hernandez CP, Rajsic S, Lanthaler B, Greil R, Tamás K, Kovácsné-Levang S, Sipos D, Kappéter A, Halda-Kiss B, Madarassi-Papp E, Hajdu E, Bende B, Konstantinos T, Moschopoulos C, Labrou E, Tsakona M, Grigoropoulos I, Kotanidou A, Fragkou P, Theodorakopoulou M, Pantazi E, Jahai E, Moukouli M, Siafakas D, Mühlbauer B, Dembinski R, Stich K, Schneider G, Nagy A, Grodová K, Kubelová M, Součková L, Švábová HK, Demlová R, Sonderlichová S, Unal S, Inkaya AC, de Bono S, Kartman CE, Adams DH, Crowe B, Yazdanapanah Y, Unal S, Schneider G, Mühlbauer B, Ødegård T, Bakkehøi G, Autran B, Bjørås M, Lambellerie XD, Mezzarri F, Guedj J, Esperou H, Lumbroso J, Welte T, Calmy A, Pischke S, Treweek S, Goetghebeur E, Doussau A, Weiss L, Hulstaert F, Botgros R, del Alamo M, Chung F, Lumbroso J, Zeitlinger M, Escalera BN, Csajka C, Williams C, Amstutz A, Rüegg CS, Burdet C, Massonnaud C, Belhadi D, Mentré F, Aroun M, Mentré F, Ehrmann S, Espoerou H, Burdet C, Falk RS, Bjordal K, Bakkehøi G, Ødegård T, Barratt-Due A. Efficacy and safety of baricitinib in hospitalized adults with severe or critical COVID-19 (Bari-SolidAct): a randomised, double-blind, placebo-controlled phase 3 trial. Crit Care 2023; 27:9. [PMID: 36627655 PMCID: PMC9830601 DOI: 10.1186/s13054-022-04205-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Baricitinib has shown efficacy in hospitalized patients with COVID-19, but no placebo-controlled trials have focused specifically on severe/critical COVID, including vaccinated participants. METHODS Bari-SolidAct is a phase-3, multicentre, randomised, double-blind, placebo-controlled trial, enrolling participants from June 3, 2021 to March 7, 2022, stopped prematurely for external evidence. Patients with severe/critical COVID-19 were randomised to Baricitinib 4 mg once daily or placebo, added to standard of care. The primary endpoint was all-cause mortality within 60 days. Participants were remotely followed to day 90 for safety and patient related outcome measures. RESULTS Two hundred ninety-nine patients were screened, 284 randomised, and 275 received study drug or placebo and were included in the modified intent-to-treat analyses (139 receiving baricitinib and 136 placebo). Median age was 60 (IQR 49-69) years, 77% were male and 35% had received at least one dose of SARS-CoV2 vaccine. There were 21 deaths at day 60 in each group, 15.1% in the baricitinib group and 15.4% in the placebo group (adjusted absolute difference and 95% CI - 0.1% [- 8·3 to 8·0]). In sensitivity analysis censoring observations after drug discontinuation or rescue therapy (tocilizumab/increased steroid dose), proportions of death were 5.8% versus 8.8% (- 3.2% [- 9.0 to 2.7]), respectively. There were 148 serious adverse events in 46 participants (33.1%) receiving baricitinib and 155 in 51 participants (37.5%) receiving placebo. In subgroup analyses, there was a potential interaction between vaccination status and treatment allocation on 60-day mortality. In a subsequent post hoc analysis there was a significant interaction between vaccination status and treatment allocation on the occurrence of serious adverse events, with more respiratory complications and severe infections in vaccinated participants treated with baricitinib. Vaccinated participants were on average 11 years older, with more comorbidities. CONCLUSION This clinical trial was prematurely stopped for external evidence and therefore underpowered to conclude on a potential survival benefit of baricitinib in severe/critical COVID-19. We observed a possible safety signal in vaccinated participants, who were older with more comorbidities. Although based on a post-hoc analysis, these findings warrant further investigation in other trials and real-world studies. Trial registration Bari-SolidAct is registered at NCT04891133 (registered May 18, 2021) and EUClinicalTrials.eu ( 2022-500385-99-00 ).
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Affiliation(s)
- Marius Trøseid
- grid.55325.340000 0004 0389 8485Section for Clinical Immunology and Infectious Diseases, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - José R. Arribas
- grid.81821.320000 0000 8970 9163Infectious Diseases Unit, Internal Medicine Department, La Paz University Hospital, IdiPAZ, Madrid, Spain ,grid.512890.7Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Lambert Assoumou
- grid.7429.80000000121866389Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie Et de Santé Publique (IPLESP), Paris, France
| | - Aleksander Rygh Holten
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - Julien Poissy
- grid.503422.20000 0001 2242 6780Lille University, Lille, France/CHU Lille - Hôpital Roger Salengro, Lille, France ,grid.457369.aL’Institut National de La Santé Et de La Recherche Médicale (Inserm), Paris, France
| | - Vida Terzić
- Maladies Infectieuses Emergentes, 75015 Paris, France ,grid.7429.80000000121866389Institut National de La Santé Et de La Recherche Médicale, INSERM, 75013 Paris, France
| | - Fulvia Mazzaferri
- grid.5611.30000 0004 1763 1124Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Jesús Rodríguez Baño
- grid.411375.50000 0004 1768 164XDepartment of Medicine, Virgen Macarena University Hospital, Seville, Spain ,grid.9224.d0000 0001 2168 1229University of Sevilla and Biomedicines Institute of Seville (IBiS)/CSIC, Seville, Spain ,grid.413448.e0000 0000 9314 1427CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Joe Eustace
- grid.7872.a0000000123318773University College Cork, Cork, Ireland
| | - Maya Hites
- grid.412157.40000 0000 8571 829XBrussels University Hospital-Erasme, Brussels, Belgium ,grid.4989.c0000 0001 2348 0746Université Libre de Bruxelles, Brussels, Belgium
| | - Michael Joannidis
- grid.5361.10000 0000 8853 2677Medical University Innsbruck, Innsbruck, Austria
| | - José-Artur Paiva
- grid.414556.70000 0000 9375 4688Intensive Care Medicine Department, Centro Hospitalar Universitário Sao Joao, Porto, Portugal ,grid.5808.50000 0001 1503 7226Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jean Reuter
- grid.418041.80000 0004 0578 0421Centre Hospitalier de Luxembourg, Service de Réanimation-Soins Intensifs, 1210 Luxembourg, Luxembourg
| | - Isabel Püntmann
- Institute of Pharmacology, Hospital Group Gesundheit Nord gGmbH, Bremen, Germany
| | - Thale D. J. H. Patrick-Brown
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
| | - Elin Westerheim
- grid.55325.340000 0004 0389 8485Section for Monitoring, Clinical Trial Unit (CTU), Oslo University Hospital, Oslo, Norway
| | - Katerina Nezvalova-Henriksen
- grid.55325.340000 0004 0389 8485Department of Haematology, Oslo University Hospital and Oslo Hospital Pharmacy, Oslo, Norway
| | - Lydie Beniguel
- grid.7429.80000000121866389Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie Et de Santé Publique (IPLESP), Paris, France
| | - Tuva Børresdatter Dahl
- grid.55325.340000 0004 0389 8485Research Institute for Internal Medicine, Oslo University Hospital, Oslo, Norway ,grid.55325.340000 0004 0389 8485Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Maude Bouscambert
- grid.413852.90000 0001 2163 3825Laboratoire de Virologie, Institut Des Agents Infectieux de Lyon, Centre National de Reference Des Virus Des Infections Respiratoires France Sud, Hospices Civils de Lyon, 69317 Lyon, France
| | - Monika Halanova
- grid.11175.330000 0004 0576 0391Department of Epidemiology, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Košice, Slovakia
| | - Zoltán Péterfi
- grid.9679.10000 0001 0663 94791St Department of Internal Medicine, Division of Infectology, University of Pécs, Pécs, Hungary
| | - Sotirios Tsiodras
- grid.5216.00000 0001 2155 0800National and Kapodistrian University of Athens, Athens, Greece ,grid.411449.d0000 0004 0622 4662University Hospital of Athens Attikon, Athens, Greece
| | - Michael Rezek
- grid.412554.30000 0004 0609 2751St. Anne University Hospital, Brno, Czech Republic
| | - Matthias Briel
- grid.410567.1Swiss Clinical Trial Organisation and Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Serhat Ünal
- grid.411920.f0000 0004 0642 1084Hacettepe University Hospital, Ankara, Turkey
| | - Martin Schlegel
- grid.6936.a0000000123222966Department of Anesthesiology and Intensive Care Medicine, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany
| | - Florence Ader
- grid.413852.90000 0001 2163 3825Hospices Civils de Lyon, Département Des Maladies Infectieuses Et Tropicales, 69004 Lyon, France ,grid.15140.310000 0001 2175 9188Centre International de Recherche en Infectiologie (CIRI), Inserm 1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Univ Lyon, 69007 Lyon, France
| | - Karine Lacombe
- grid.7429.80000000121866389Sorbonne Université, Institut Pierre-Louis d’Épidemiologie Et de Santé Publique, INSERM, 75013 Paris, France ,grid.412370.30000 0004 1937 1100APHP, Hôpital Saint-Antoine, Service de Maladies Infectieuses Et Tropicales, 75012 Paris, France
| | - Cecilie Delphin Amdal
- grid.55325.340000 0004 0389 8485Research support service and Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Serge Rodrigues
- grid.7429.80000000121866389Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie Et de Santé Publique (IPLESP), Paris, France
| | - Kristian Tonby
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Deptartment of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Alexandre Gaudet
- grid.410463.40000 0004 0471 8845Critical Care Center, Department of Intensive Care Medicine, CHU Lille, 59000 Lille, France ,grid.503422.20000 0001 2242 6780Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d’Infection Et d’Immunité de Lille, 59000 Lille, France
| | - Lars Heggelund
- grid.459157.b0000 0004 0389 7802Medical Department, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Joy Mootien
- grid.414085.c0000 0000 9480 048XService, de Réanimation Médiale, GHRMSA Hopital Emile Muller, Mulhouse, France
| | - Asgeir Johannessen
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.417292.b0000 0004 0627 3659Department of Infectious Diseases, Vestfold Hospital Trust, Tønsberg, Norway
| | - Jannicke Horjen Møller
- grid.412835.90000 0004 0627 2891Department of Intensive Care Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Beatriz Diaz Pollan
- grid.81821.320000 0000 8970 9163Infectious Diseases Unit, Internal Medicine Department, La Paz University Hospital, Madrid, Spain ,grid.81821.320000 0000 8970 9163Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), IdiPAZ, Madrid, Spain
| | - Anders Aune Tveita
- grid.414168.e0000 0004 0627 3595Department of Medicine, Bærum Hospital, Vestre Viken, Bærum, Norway
| | - Anders Benjamin Kildal
- grid.412244.50000 0004 4689 5540Department of Anesthesiology and Intensive Care, University Hospital of North Norway, Tromsø, Norway
| | - Jean-Christophe Richard
- grid.413306.30000 0004 4685 6736Service de Médecine Intensive-Réanimation, Hôpital de La Croix - Rousse - HCL, Lyon, France ,grid.7429.80000000121866389CREATIS INSERM U1206-CNRS UMR 5220, Lyon, France
| | - Olav Dalgard
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.411279.80000 0000 9637 455XAkershus University Hospital, Lørenskog, Norway
| | - Victoria Charlotte Simensen
- grid.418193.60000 0001 1541 4204Division of Health Services, Department of Global Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Aliou Baldé
- grid.7429.80000000121866389Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie Et de Santé Publique (IPLESP), Paris, France
| | - Lucie de Gastines
- Maladies Infectieuses Emergentes, 75015 Paris, France ,grid.7429.80000000121866389Institut National de La Santé Et de La Recherche Médicale, INSERM, 75013 Paris, France
| | | | - Burç Aydin
- grid.55325.340000 0004 0389 8485Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Fridtjof Lund-Johansen
- grid.55325.340000 0004 0389 8485Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Mary-Anne Trabaud
- grid.134996.00000 0004 0593 702XLaboratoire de Virologie, Institut Des Agents Infectieux de Lyon, Centre National de Reference Des Virus Respiratoires France Sud, 69317 Hospices Civils de LyonLyon, France
| | - Alpha Diallo
- Maladies Infectieuses Emergentes, 75015 Paris, France ,grid.7429.80000000121866389Institut National de La Santé Et de La Recherche Médicale, INSERM, 75013 Paris, France
| | - Bente Halvorsen
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - John-Arne Røttingen
- grid.418193.60000 0001 1541 4204Norwegian Institute of Public Health, Oslo, Norway
| | - Evelina Tacconelli
- grid.5611.30000 0004 1763 1124Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy ,grid.411475.20000 0004 1756 948XVerona University Hospital, Verona, Italy
| | - Yazdan Yazdanpanah
- grid.512950.aUniversité de Paris, IAME, INSERM, 75018 Paris, France ,grid.411119.d0000 0000 8588 831XAP-HP, Hôpital Bichat, Service de Maladies Infectieuses Et Tropicales, 75018 Paris, France
| | - Inge C. Olsen
- grid.55325.340000 0004 0389 8485Department of Research Support for Clinical Trials, Oslo University Hospital, Oslo, Norway
| | - Dominique Costagliola
- grid.7429.80000000121866389Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie Et de Santé Publique (IPLESP), Paris, France
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Gregersen I, Ueland T, Holter JC, Olsen MB, Michelsen AE, Murphy SL, Tveita AA, Henriksen KN, Hoel H, Nordberg LB, Holten AR, Edvardsen T, Yang K, Heggelund L, Trøseid M, Müller F, Kildal AB, Dyrhol-Riise AM, Barratt-Due A, Dahl TB, Aukrust P, Halvorsen B. CXCL16 associates with adverse outcome and cardiac involvement in hospitalized patients with Covid-19. J Infect 2022; 85:702-769. [PMID: 36216188 PMCID: PMC9546500 DOI: 10.1016/j.jinf.2022.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Ida Gregersen
- Research Institute for Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo 0027, Norway,Corresponding author
| | - Thor Ueland
- Research Institute for Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo 0027, Norway,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo 0318, Norway,Thrombosis Research and Expertise Center, University of Tromsø, Tromsø, Norway
| | - Jan Cato Holter
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo 0318, Norway,Department of Microbiology, Oslo University Hospital, Oslo 0424, Norway
| | - Maria Belland Olsen
- Research Institute for Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo 0027, Norway
| | - Annika E Michelsen
- Research Institute for Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo 0027, Norway,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo 0318, Norway
| | - Sarah L Murphy
- Research Institute for Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo 0027, Norway,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo 0318, Norway
| | - Anders Aune Tveita
- Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum 1346, Norway,Division of Laboratory Medicine, Department of Immunology, Oslo University Hospital, Oslo 0424, Norway
| | - Katerina Nezvalova Henriksen
- Department of Hematology, Oslo University Hospital, Oslo, Norway,Hospital Pharmacies, South-Eastern Norway Enterprise, Oslo, Norway
| | - Hedda Hoel
- Research Institute for Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo 0027, Norway,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo 0318, Norway,Medical Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | | | - Aleksander Rygh Holten
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo 0318, Norway,Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway
| | - Kuan Yang
- Research Institute for Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo 0027, Norway
| | - Lars Heggelund
- Department of Internal Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen 3004, Norway,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen 5009, Norway
| | - Marius Trøseid
- Research Institute for Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo 0027, Norway,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo 0318, Norway,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Fredrik Müller
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo 0318, Norway,Department of Microbiology, Oslo University Hospital, Oslo 0424, Norway
| | - Anders Benjamin Kildal
- Department of Anesthesiology and Intensive Care, University Hospital of North Norway, Tromsø, Norway
| | - Anne Ma Dyrhol-Riise
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo 0318, Norway,Department of Infectious Diseases, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Andreas Barratt-Due
- Division of Laboratory Medicine, Department of Immunology, Oslo University Hospital, Oslo 0424, Norway,Department of Anaesthesia and Intensive Care Medicine, Oslo University Hospital, Oslo, Norway
| | - Tuva B Dahl
- Research Institute for Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo 0027, Norway,Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - Pål Aukrust
- Research Institute for Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo 0027, Norway,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo 0318, Norway,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Bente Halvorsen
- Research Institute for Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo 0027, Norway,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo 0318, Norway
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3
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Tveita A, Murphy SL, Holter JC, Kildal AB, Michelsen AE, Lerum TV, Kaarbø M, Heggelund L, Holten AR, Finbråten AK, Müller KE, Mathiessen A, Bøe S, Fevang B, Granerud BK, Tonby K, Lind A, Dudman SG, Henriksen KN, Müller F, Skjønsberg OH, Trøseid M, Barratt-Due A, Dyrhol-Riise AM, Aukrust P, Halvorsen B, Dahl TB, Ueland T. High Circulating Levels of the Homeostatic Chemokines CCL19 and CCL21 Predict Mortality and Disease Severity in COVID-19. J Infect Dis 2022; 226:2150-2160. [PMID: 35876699 PMCID: PMC9384496 DOI: 10.1093/infdis/jiac313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/12/2022] [Accepted: 07/28/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Immune dysregulation is a major factor in the development of severe coronavirus disease 2019 (COVID-19). The homeostatic chemokines CCL19 and CCL21 have been implicated as mediators of tissue inflammation, but data on their regulation in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is limited. We thus investigated the levels of these chemokines in COVID-19 patients. METHODS Serial blood samples were obtained from patients hospitalized with COVID-19 (n = 414). Circulating CCL19 and CCL21 levels during hospitalization and 3-month follow-up were analyzed. In vitro assays and analysis of RNAseq data from public repositories were performed to further explore possible regulatory mechanisms. RESULTS A consistent increase in circulating levels of CCL19 and CCL21 was observed, with high levels correlating with disease severity measures, including respiratory failure, need for intensive care, and 60-day all-cause mortality. High levels of CCL21 at admission were associated with persisting impairment of pulmonary function at the 3-month follow-up. CONCLUSIONS Our findings highlight CCL19 and CCL21 as markers of immune dysregulation in COVID-19. This may reflect aberrant regulation triggered by tissue inflammation, as observed in other chronic inflammatory and autoimmune conditions. Determination of the source and regulation of these chemokines and their effects on lung tissue is warranted to further clarify their role in COVID-19. CLINICAL TRIALS REGISTRATION NCT04321616 and NCT04381819.
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Affiliation(s)
- Anders Tveita
- Correspondence: Anders Tveita, MD, PhD, Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, 1346 Gjettum, Norway ()
| | | | | | - Anders Benjamin Kildal
- Department of Anesthesiology and Intensive Care, University Hospital of North Norway, Tromsø, Norway
| | - Annika E Michelsen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Tøri Vigeland Lerum
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Pulmonary Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Mari Kaarbø
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | - Lars Heggelund
- Department of Internal Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Aleksander Rygh Holten
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Karl Erik Müller
- Department of Internal Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | | | - Simen Bøe
- Department of Anesthesiology and Intensive Care, Hammerfest County Hospital, Hammerfest, Norway
| | - Børre Fevang
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Beathe Kiland Granerud
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | - Kristian Tonby
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Infectious Diseases, Oslo University Hospital Ullevål, Oslo, Norway
| | - Andreas Lind
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | - Susanne Gjeruldsen Dudman
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | - Katerina Nezvalova Henriksen
- Department of Hematology, Oslo University Hospital, Oslo, Norway,Hospital Pharmacies, South-Eastern Norway Enterprise, Oslo, Norway
| | - Fredrik Müller
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | - Ole Henning Skjønsberg
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Pulmonary Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Marius Trøseid
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Andreas Barratt-Due
- Division of Laboratory Medicine, Department of Immunology, Oslo University Hospital, Oslo, Norway,Department of Anesthesia and Intensive Care Medicine, Oslo University Hospital, Oslo, Norway
| | - Anne Ma Dyrhol-Riise
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Infectious Diseases, Oslo University Hospital Ullevål, Oslo, Norway
| | - Pål Aukrust
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Bente Halvorsen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
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Vestad B, Ueland T, Lerum TV, Dahl TB, Holm K, Barratt-Due A, Kåsine T, Dyrhol-Riise AM, Stiksrud B, Tonby K, Hoel H, Olsen IC, Henriksen KN, Tveita A, Manotheepan R, Haugli M, Eiken R, Berg Å, Halvorsen B, Lekva T, Ranheim T, Michelsen AE, Kildal AB, Johannessen A, Thoresen L, Skudal H, Kittang BR, Olsen RB, Ystrøm CM, Skei NV, Hannula R, Aballi S, Kvåle R, Skjønsberg OH, Aukrust P, Hov JR, Trøseid M. Respiratory dysfunction three months after severe COVID-19 is associated with gut microbiota alterations. J Intern Med 2022; 291:801-812. [PMID: 35212063 PMCID: PMC9115297 DOI: 10.1111/joim.13458] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although coronavirus disease 2019 (COVID-19) is primarily a respiratory infection, mounting evidence suggests that the gastrointestinal tract is involved in the disease, with gut barrier dysfunction and gut microbiota alterations being related to disease severity. Whether these alterations persist and are related to long-term respiratory dysfunction remains unknown. METHODS Plasma was collected during hospital admission and after 3 months from the NOR-Solidarity trial (n = 181) and analyzed for markers of gut barrier dysfunction and inflammation. At the 3-month follow-up, pulmonary function was assessed by measuring the diffusing capacity of the lungs for carbon monoxide (DLCO ). Rectal swabs for gut microbiota analyses were collected (n = 97) and analyzed by sequencing the 16S rRNA gene. RESULTS Gut microbiota diversity was reduced in COVID-19 patients with respiratory dysfunction, defined as DLCO below the lower limit of normal 3 months after hospitalization. These patients also had an altered global gut microbiota composition, with reduced relative abundance of 20 bacterial taxa and increased abundance of five taxa, including Veillonella, potentially linked to fibrosis. During hospitalization, increased plasma levels of lipopolysaccharide-binding protein (LBP) were strongly associated with respiratory failure, defined as pO2 /fiO2 (P/F ratio) <26.6 kPa. LBP levels remained elevated during and after hospitalization and were associated with low-grade inflammation and respiratory dysfunction after 3 months. CONCLUSION Respiratory dysfunction after COVID-19 is associated with altered gut microbiota and persistently elevated LBP levels. Our results should be regarded as hypothesis generating, pointing to a potential gut-lung axis that should be further investigated in relation to long-term pulmonary dysfunction and long COVID.
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Affiliation(s)
- Beate Vestad
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.,Norwegian PSC Research Center, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Thor Ueland
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tøri Vigeland Lerum
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Pulmonary Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Tuva Børresdatter Dahl
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.,Division of Critical Care and Emergencies, Oslo University Hospital, Oslo, Norway
| | - Kristian Holm
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.,Norwegian PSC Research Center, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Andreas Barratt-Due
- Division of Critical Care and Emergencies, Oslo University Hospital, Oslo, Norway.,Division of Laboratory Medicine, Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Trine Kåsine
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Critical Care and Emergencies, Oslo University Hospital, Oslo, Norway
| | - Anne Ma Dyrhol-Riise
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Birgitte Stiksrud
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Kristian Tonby
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Hedda Hoel
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Medical Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Inge Christoffer Olsen
- Department of Research Support for Clinical Trials, Oslo University Hospital, Oslo, Norway
| | - Katerina Nezvalova Henriksen
- Department of Haematology, Oslo University Hospital, Oslo, Norway.,Hospital Pharmacies, South-Eastern Norway Enterprise, Oslo, Norway
| | - Anders Tveita
- Medical Department, Baerum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | | | - Mette Haugli
- Department of Infectious Diseases, Sørlandet Hospital SSK, Kristiansand, Norway
| | - Ragnhild Eiken
- Department of Infectious Diseases, Innlandet Hospital Trust, Lillehammer, Norway
| | - Åse Berg
- Department of Infectious Diseases, Stavanger University Hospital, Stavanger, Norway
| | - Bente Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tove Lekva
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Trine Ranheim
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Annika Elisabeth Michelsen
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anders Benjamin Kildal
- Department of Anesthesiology and Intensive Care, University Hospital of North Norway, Tromsø, Norway
| | - Asgeir Johannessen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Infectious Diseases, Vestfold Hospital Trust, Tønsberg, Norway
| | - Lars Thoresen
- Department of Medicine, Ringerike Hospital, Vestre Viken Hospital Trust, Ringerike, Norway
| | - Hilde Skudal
- Division of Infectious Diseases, Telemark Hospital Trust, Skien, Norway
| | | | | | | | - Nina Vibeche Skei
- Department of Anesthesia and Intensive Care, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Raisa Hannula
- Department of Infectious Diseases, Trondheim University Hospital, Trondheim, Norway
| | - Saad Aballi
- Department of Infectious Diseases, Østfold Hospital Kalnes, Grålum, Norway
| | - Reidar Kvåle
- Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Ole Henning Skjønsberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Pulmonary Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Johannes Roksund Hov
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.,Norwegian PSC Research Center, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Marius Trøseid
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Oslo, Norway
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Ueland T, Hausberg I, Mørtberg TV, Dahl TB, Lerum TV, Michelsen A, Ranheim T, Nezvalova Henriksen K, Dyrhol-Riise AM, Holme PA, Aaløkken TM, Skjønsberg OH, Barratt-Due A, Ahlén MT, Aukrust P, Halvorsen B. Anti-PF4/polyanion antibodies in COVID-19 patients are associated with disease severity and pulmonary pathology. Platelets 2022; 33:640-644. [DOI: 10.1080/09537104.2022.2042238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Thor Ueland
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Clinical Medicine, Thrombosis Research and Expertise Center (TREC), UiT-The Arctic University of Norway, Tromsø, Norway
| | - Ingvild Hausberg
- Norwegian National Unit for Platelet Immunology, University Hospital of North Norway, Tromsø, Norway
| | - Trude Victoria Mørtberg
- Norwegian National Unit for Platelet Immunology, University Hospital of North Norway, Tromsø, Norway
| | - Tuva Børresdatter Dahl
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway
| | - Tøri Vigeland Lerum
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Pulmonary Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Annika Michelsen
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trine Ranheim
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Anne Ma Dyrhol-Riise
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Pål André Holme
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Haematology, Oslo University Hospital, Oslo, Norway
| | - Trond Mogens Aaløkken
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Radiology and Nuclear Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Ole Henning Skjønsberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Pulmonary Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Andreas Barratt-Due
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Maria Therese Ahlén
- Norwegian National Unit for Platelet Immunology, University Hospital of North Norway, Tromsø, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Bente Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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