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Hawerkamp HC, Dyer AH, Patil ND, McElheron M, O’Dowd N, O’Doherty L, Mhaonaigh AU, George AM, O’Halloran AM, Reddy C, Kenny RA, Little MA, Martin-Loeches I, Bergin C, Kennelly SP, Donnelly SC, Bourke NM, Long A, Sui J, Doherty DG, Conlon N, Cheallaigh CN, Fallon PG. Characterisation of the pro-inflammatory cytokine signature in severe COVID-19. Front Immunol 2023; 14:1170012. [PMID: 37063871 PMCID: PMC10101230 DOI: 10.3389/fimmu.2023.1170012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/20/2023] [Indexed: 04/03/2023] Open
Abstract
Clinical outcomes from infection with SARS-CoV-2, the cause of the COVID-19 pandemic, are remarkably variable ranging from asymptomatic infection to severe pneumonia and death. One of the key drivers of this variability is differing trajectories in the immune response to SARS-CoV-2 infection. Many studies have noted markedly elevated cytokine levels in severe COVID-19, although results vary by cohort, cytokine studied and sensitivity of assay used. We assessed the immune response in acute COVID-19 by measuring 20 inflammatory markers in 118 unvaccinated patients with acute COVID-19 (median age: 70, IQR: 58-79 years; 48.3% female) recruited during the first year of the pandemic and 44 SARS-CoV-2 naïve healthy controls. Acute COVID-19 was associated with marked elevations in nearly all pro-inflammatory markers, whilst eleven markers (namely IL-1β, IL-2, IL-6, IL-10, IL-18, IL-23, IL-33, TNF-α, IP-10, G-CSF and YKL-40) were associated with disease severity. We observed significant correlations between nearly all markers elevated in those infected with SARS-CoV-2 consistent with widespread immune dysregulation. Principal component analysis highlighted a pro-inflammatory cytokine signature (with strongest contributions from IL-1β, IL-2, IL-6, IL-10, IL-33, G-CSF, TNF-α and IP-10) which was independently associated with severe COVID-19 (aOR: 1.40, 1.11-1.76, p=0.005), invasive mechanical ventilation (aOR: 1.61, 1.19-2.20, p=0.001) and mortality (aOR 1.57, 1.06-2.32, p = 0.02). Our findings demonstrate elevated cytokines and widespread immune dysregulation in severe COVID-19, adding further evidence for the role of a pro-inflammatory cytokine signature in severe and critical COVID-19.
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Affiliation(s)
- Heike C. Hawerkamp
- School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Adam H. Dyer
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland
- *Correspondence: Adam H. Dyer, ; Padraic G. Fallon,
| | - Neha D. Patil
- School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Matt McElheron
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Niamh O’Dowd
- School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Laura O’Doherty
- Department of Infectious Diseases, St James’s Hospital, Dublin, Ireland
| | - Aisling Ui Mhaonaigh
- Trinity Kidney Centre, Trinity Translational Medicine Institute, Trinity College, Dublin, Ireland
| | - Angel M. George
- Trinity Kidney Centre, Trinity Translational Medicine Institute, Trinity College, Dublin, Ireland
| | - Aisling M. O’Halloran
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Conor Reddy
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Mark A. Little
- Trinity Kidney Centre, Trinity Translational Medicine Institute, Trinity College, Dublin, Ireland
| | | | - Colm Bergin
- Department of Infectious Diseases, St James’s Hospital, Dublin, Ireland
- Department of Clinical Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Sean P. Kennelly
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | - Seamas C. Donnelly
- School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- Department of Clinical Medicine, Tallaght University Hospital, Dublin, Ireland
| | - Nollaig M. Bourke
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Aideen Long
- Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Jacklyn Sui
- Department of Immunology, St James’s Hospital, Dublin, Ireland
| | - Derek G. Doherty
- Department of Immunology, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Niall Conlon
- Department of Immunology, St James’s Hospital, Dublin, Ireland
| | - Cliona Ni Cheallaigh
- Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Padraic G. Fallon
- School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
- *Correspondence: Adam H. Dyer, ; Padraic G. Fallon,
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