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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Benotmane I, Gautier-Vargas G, Wendling MJ, Perrin P, Velay A, Bassand X, Bedo D, Baldacini C, Sagnard M, Bozman DF, Della-Chiesa M, Solis M, Gallais F, Cognard N, Olagne J, Delagrèverie H, Gontard L, Panaget B, Marx D, Heibel F, Braun-Parvez L, Moulin B, Caillard S, Fafi-Kremer S. In-depth virological assessment of kidney transplant recipients with COVID-19. Am J Transplant 2020; 20:3162-3172. [PMID: 32777130 PMCID: PMC7436721 DOI: 10.1111/ajt.16251] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [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: 06/18/2020] [Revised: 07/23/2020] [Accepted: 07/29/2020] [Indexed: 01/25/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread widely, causing coronavirus disease 2019 (COVID-19) and significant mortality. However, data on viral loads and antibody kinetics in immunocompromised populations are lacking. We aimed to determine nasopharyngeal and plasma viral loads via reverse transcription-polymerase chain reaction and SARS-CoV-2 serology via enzyme-linked immunosorbent assay and study their association with severe forms of COVID-19 and death in kidney transplant recipients. In this study, we examined hospitalized kidney transplant recipients with nonsevere (n = 21) and severe (n = 19) COVID-19. SARS-CoV-2 nasopharyngeal and plasma viral load and serological response were evaluated based on outcomes and disease severity. Ten recipients (25%) displayed persistent viral shedding 30 days after symptom onset. The SARS-CoV-2 viral load of the upper respiratory tract was not associated with severe COVID-19, whereas the plasma viral load was associated with COVID-19 severity (P = .010) and mortality (P = .010). All patients harbored antibodies during the second week after symptom onset that persisted for 2 months. We conclude that plasma viral load is associated with COVID-19 morbidity and mortality, whereas nasopharyngeal viral load is not. SARS-CoV-2 shedding is prolonged in kidney transplant recipients and the humoral response to SARS-CoV-2 does not show significant impairment in this series of transplant recipients.
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Key Words
- clinical research/practice
- complication: infectious
- immune deficiency
- infection and infectious agents – viral
- infectious disease
- kidney transplantation/nephrology
- cni, calcineurin inhibitor
- covid-19, coronavirus disease 2019
- ct, computed tomography
- d, day after symptom onset
- icu, intensive care unit
- ig, immunoglobulin
- il, interleukin
- ktr, kidney transplant recipients
- mpa, mycophenolic acid
- roc, receiver operating characteristic
- rt-pcr, reverse transcription-polymerase chain reaction
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
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Affiliation(s)
- Ilies Benotmane
- Department of Nephrology and Transplantation, Strasbourg University Hospital, Strasbourg, France,Department of Virology, Strasbourg University Hospital, Strasbourg, France,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France
| | - Gabriela Gautier-Vargas
- Department of Nephrology and Transplantation, Strasbourg University Hospital, Strasbourg, France
| | | | - Peggy Perrin
- Department of Nephrology and Transplantation, Strasbourg University Hospital, Strasbourg, France,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France
| | - Aurélie Velay
- Department of Virology, Strasbourg University Hospital, Strasbourg, France,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France
| | - Xavier Bassand
- Department of Nephrology and Transplantation, Strasbourg University Hospital, Strasbourg, France
| | - Dimitri Bedo
- Department of Nephrology and Transplantation, Strasbourg University Hospital, Strasbourg, France
| | - Clément Baldacini
- Department of Nephrology and Transplantation, Strasbourg University Hospital, Strasbourg, France
| | - Mylène Sagnard
- Department of Nephrology and Transplantation, Strasbourg University Hospital, Strasbourg, France
| | - Dogan-Firat Bozman
- Department of Nephrology and Transplantation, Strasbourg University Hospital, Strasbourg, France
| | - Margaux Della-Chiesa
- Department of Nephrology and Transplantation, Strasbourg University Hospital, Strasbourg, France
| | - Morgane Solis
- Department of Virology, Strasbourg University Hospital, Strasbourg, France,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France
| | - Floriane Gallais
- Department of Virology, Strasbourg University Hospital, Strasbourg, France,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France
| | - Noëlle Cognard
- Department of Nephrology and Transplantation, Strasbourg University Hospital, Strasbourg, France
| | - Jérôme Olagne
- Department of Nephrology and Transplantation, Strasbourg University Hospital, Strasbourg, France
| | | | - Louise Gontard
- Department of Virology, Strasbourg University Hospital, Strasbourg, France
| | - Baptiste Panaget
- Department of Virology, Strasbourg University Hospital, Strasbourg, France
| | - David Marx
- Department of Nephrology and Transplantation, Strasbourg University Hospital, Strasbourg, France
| | - Françoise Heibel
- Department of Nephrology and Transplantation, Strasbourg University Hospital, Strasbourg, France
| | - Laura Braun-Parvez
- Department of Nephrology and Transplantation, Strasbourg University Hospital, Strasbourg, France
| | - Bruno Moulin
- Department of Nephrology and Transplantation, Strasbourg University Hospital, Strasbourg, France,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France
| | - Sophie Caillard
- Department of Nephrology and Transplantation, Strasbourg University Hospital, Strasbourg, France,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France
| | - Samira Fafi-Kremer
- Department of Virology, Strasbourg University Hospital, Strasbourg, France,INSERM U1109, LabEx TRANSPLANTEX, Strasbourg, France,Correspondence Samira Fafi-Kremer
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Benotmane I, Perrin P, Gautier-Vargas G, Bassand X, Bedo D, Baldacini C, Sagnard M, Moulin B, Fafi-Kremer S, Caillard S. Prédiction de la sévérité de la COVID-19 par les biomarqueurs du syndrome de relargage cytokinique au sein d’une population de transplantés rénaux. Nephrol Ther 2020. [PMCID: PMC7494287 DOI: 10.1016/j.nephro.2020.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction Les données concernant la coronavirus disease-2019 (COVID-19) dans la population de transplantés rénaux (TR) sont peu nombreuses. Alors que les marqueurs de l’inflammation, d’atteinte myocardique et de coagulopathie sont associés à la gravité et à la mortalité au sein de la population immunocompétente infectée par le severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), aucune étude n’a évalué ces marqueurs chez des TR atteints de la COVID-19. Description Dans cette étude de cohorte portant sur 50 patients TR atteints de la COVID-19, nous avons déterminé les facteurs de risque cliniques et biologiques liés à la gravité et la mortalité de la maladie. Méthodes Selon la sévérité de l’atteinte clinique, la cohorte a été divisée en 3 groupes : – patients avec une atteinte peu sévère ayant bénéficié d’une prise en charge ambulatoire (n = 9) ; – patients hospitalisés avec une atteinte modérée (n = 21) ; – des patients hospitalisés avec une atteinte sévère (n = 20). Résultats La fièvre, les signes respiratoires et digestifs étaient les trois signes les plus fréquents. Le taux de mortalité à 30 jours des patients hospitalisés était de 19,5 %. L’âge supérieur à 60 ans (85 % vs 43 %, p = 0,01), l’obésité (70 % vs 33,3, p = 0,02) et la dyspnée (100 % vs 42,9 %, p < 0,0001) étaient plus fréquents dans le groupe présentant une atteinte sévère. L’élévation des marqueurs de l’inflammation (CRP > 100 mg/L et Interleukin-6 > 65 ng/L), suivis par une élévation de la troponine I hypersensible (> 30 ng/L) et des D-dimères (> 960 ng/mL), était fortement associée à la sévérité et la mortalité de la COVID-19 (Fig. 1). Conclusion Le pronostic de la COVID-19 au sein de la population des TR est lié aux marqueurs du syndrome de relargage cytokinique. Un monitorage de ces marqueurs permettrait de cibler la population à risque de complication et d’améliorer leur prise en charge en utilisant des traitements ciblés.
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