Type 1 inflammatory endotype relates to low compliance, lung fibrosis, and severe complications in COVID-19.

Abstract

BACKGROUND:

Coronavirus disease 2019 (COVID-19) is an acute respiratory disease; approximately 5% of patients developing severe COVID-19. It is known that cytokine release is associated with disease severity, but the relationship between the different clinical phenotypes and inflammatory endotypes is not well understood.

OBJECTIVE:

This study investigated the association between inflammatory biomarker-based endotypes and severe COVID-19 phenotypes.

METHODS:

Interleukin (IL) -6, C-reactive protein (CRP), C-X-C motif chemokine (CXCL) 9, IL-18, C-C motif chemokine (CCL) 3, CCL17, IL-10, and vascular endothelial growth factor (VEGF) were measured in 57 COVID-19 patients, and their association with clinical characteristics was examined using a cluster analysis.

RESULTS:

Significantly higher blood levels of the eight inflammatory markers were noted in patients who developed acute respiratory distress syndrome (ARDS) than in those who did not develop ARDS (non-ARDS). Using a cluster analysis, the patient groups were classified into four clusters, of which two had patients with high IL-6 and CRP levels. In the cluster with high levels of Type 1 (T1) inflammatory markers such as CXCL9 and IL-18, 85% of the patients had ARDS, 65% of the patients developed acute kidney injury (AKI), and 78% of the patients developed pulmonary fibrosis.

CONCLUSIONS:

In the cluster with high levels of T1 inflammatory markers, the patients frequently suffered from tissue damage, manifested as ARDS and AKI. Our findings identified distinct T1 inflammatory endotypes of COVID-19 and suggest the importance of controlling inflammation by monitoring T1 biomarkers and treating accordingly to limit the severity of the disease.

• Authors: Takehiro Hasegawa, Atsushi Nakagawa, Kohjin Suzuki, Kazuto Yamashita, Saya Yamashita, Niina Iwanaga, Eiya Tamada, Kenta Noda, Keisuke Tomii
• Journal: Cytokine (Cytokine) Vol. 148 Pg. 155618 (12 2021) ISSN: 1096-0023 [Electronic] England
• PMID: 34127355 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Chemical References

• Biomarkers

Topics

• Aged
• Biomarkers (blood)
• COVID-19 (blood, complications, physiopathology, virology)
• Cluster Analysis
• Disease Progression
• Female
• Humans
• Inflammation (blood, complications, pathology)
• Lung Compliance
• Male
• Middle Aged
• Pulmonary Fibrosis (blood, complications, physiopathology)
• Respiratory Distress Syndrome (blood, complications)
• SARS-CoV-2 (physiology)