Predictive markers related to local and systemic inflammation in severe COVID-19-associated ARDS: a prospective single-center analysis
Abstract Background As the COVID-19 pandemic strains healthcare systems worldwide, finding predictive markers of severe courses remains urgent. Most research so far was limited to selective questions hindering general assumptions for short- and long-term outcome. Methods In this prospective single-c...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-023-07980-z |
| _version_ | 1828063922671845376 |
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| author | Jan Nikolaus Lieberum Sandra Kaiser Johannes Kalbhenn Hartmut Bürkle Nils Schallner |
| author_facet | Jan Nikolaus Lieberum Sandra Kaiser Johannes Kalbhenn Hartmut Bürkle Nils Schallner |
| author_sort | Jan Nikolaus Lieberum |
| collection | DOAJ |
| description | Abstract Background As the COVID-19 pandemic strains healthcare systems worldwide, finding predictive markers of severe courses remains urgent. Most research so far was limited to selective questions hindering general assumptions for short- and long-term outcome. Methods In this prospective single-center biomarker study, 47 blood- and 21 bronchoalveolar lavage (BAL) samples were collected from 47 COVID-19 intensive care unit (ICU) patients upon admission. Expression of inflammatory markers toll-like receptor 3 (TLR3), heme oxygenase-1 (HO-1), interleukin (IL)-6, IL-8, leukocyte counts, procalcitonin (PCT) and carboxyhemoglobin (CO-Hb) was compared to clinical course. Clinical assessment comprised acute local organ damage, acute systemic damage, mortality and outcome after 6 months. Results PCT correlated with acute systemic damage and was the best predictor for quality of life (QoL) after 6 months (r = − 0.4647, p = 0.0338). Systemic TLR3 negatively correlated with impaired lung function (ECMO/ECLS: r = − 0.3810, p = 0.0107) and neurological short- (RASS mean: r = 0.4474, p = 0.0023) and long-term outcome (mRS after 6 m: r = − 0.3184, p = 0.0352). Systemic IL-8 correlated with impaired lung function (ECMO/ECLS: r = 0.3784, p = 0.0161) and neurological involvement (RASS mean: r = − 0.5132, p = 0.0007). IL-6 in BAL correlated better to the clinical course than systemic IL-6. Using three multivariate regression models, we describe prediction models for local and systemic damage as well as QoL. CO-Hb mean and max were associated with higher mortality. Conclusions Our predictive models using the combination of Charlson Comorbidity Index, sex, procalcitonin, systemic TLR3 expression and IL-6 and IL-8 in BAL were able to describe a broad range of clinically relevant outcomes in patients with severe COVID-19-associated ARDS. Using these models might proof useful in risk stratification and predicting disease course in the future. Trial registration The trial was registered with the German Clinical Trials Register (Trial-ID DRKS00021522, registered 22/04/2020). |
| first_indexed | 2024-04-10T22:50:42Z |
| format | Article |
| id | doaj.art-a7a8aa0f1dde423eb405e925ebe34e21 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-04-10T22:50:42Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-a7a8aa0f1dde423eb405e925ebe34e212023-01-15T12:05:19ZengBMCBMC Infectious Diseases1471-23342023-01-0123111610.1186/s12879-023-07980-zPredictive markers related to local and systemic inflammation in severe COVID-19-associated ARDS: a prospective single-center analysisJan Nikolaus Lieberum0Sandra Kaiser1Johannes Kalbhenn2Hartmut Bürkle3Nils Schallner4Department of Anesthesiology and Critical Care Medicine, Medical Center, University of FreiburgDepartment of Anesthesiology and Critical Care Medicine, Medical Center, University of FreiburgDepartment of Anesthesiology and Critical Care Medicine, Medical Center, University of FreiburgDepartment of Anesthesiology and Critical Care Medicine, Medical Center, University of FreiburgDepartment of Anesthesiology and Critical Care Medicine, Medical Center, University of FreiburgAbstract Background As the COVID-19 pandemic strains healthcare systems worldwide, finding predictive markers of severe courses remains urgent. Most research so far was limited to selective questions hindering general assumptions for short- and long-term outcome. Methods In this prospective single-center biomarker study, 47 blood- and 21 bronchoalveolar lavage (BAL) samples were collected from 47 COVID-19 intensive care unit (ICU) patients upon admission. Expression of inflammatory markers toll-like receptor 3 (TLR3), heme oxygenase-1 (HO-1), interleukin (IL)-6, IL-8, leukocyte counts, procalcitonin (PCT) and carboxyhemoglobin (CO-Hb) was compared to clinical course. Clinical assessment comprised acute local organ damage, acute systemic damage, mortality and outcome after 6 months. Results PCT correlated with acute systemic damage and was the best predictor for quality of life (QoL) after 6 months (r = − 0.4647, p = 0.0338). Systemic TLR3 negatively correlated with impaired lung function (ECMO/ECLS: r = − 0.3810, p = 0.0107) and neurological short- (RASS mean: r = 0.4474, p = 0.0023) and long-term outcome (mRS after 6 m: r = − 0.3184, p = 0.0352). Systemic IL-8 correlated with impaired lung function (ECMO/ECLS: r = 0.3784, p = 0.0161) and neurological involvement (RASS mean: r = − 0.5132, p = 0.0007). IL-6 in BAL correlated better to the clinical course than systemic IL-6. Using three multivariate regression models, we describe prediction models for local and systemic damage as well as QoL. CO-Hb mean and max were associated with higher mortality. Conclusions Our predictive models using the combination of Charlson Comorbidity Index, sex, procalcitonin, systemic TLR3 expression and IL-6 and IL-8 in BAL were able to describe a broad range of clinically relevant outcomes in patients with severe COVID-19-associated ARDS. Using these models might proof useful in risk stratification and predicting disease course in the future. Trial registration The trial was registered with the German Clinical Trials Register (Trial-ID DRKS00021522, registered 22/04/2020).https://doi.org/10.1186/s12879-023-07980-zCOVID-19ICUTLR3IL-6IL-8Carboxyhemoglobin |
| spellingShingle | Jan Nikolaus Lieberum Sandra Kaiser Johannes Kalbhenn Hartmut Bürkle Nils Schallner Predictive markers related to local and systemic inflammation in severe COVID-19-associated ARDS: a prospective single-center analysis BMC Infectious Diseases COVID-19 ICU TLR3 IL-6 IL-8 Carboxyhemoglobin |
| title | Predictive markers related to local and systemic inflammation in severe COVID-19-associated ARDS: a prospective single-center analysis |
| title_full | Predictive markers related to local and systemic inflammation in severe COVID-19-associated ARDS: a prospective single-center analysis |
| title_fullStr | Predictive markers related to local and systemic inflammation in severe COVID-19-associated ARDS: a prospective single-center analysis |
| title_full_unstemmed | Predictive markers related to local and systemic inflammation in severe COVID-19-associated ARDS: a prospective single-center analysis |
| title_short | Predictive markers related to local and systemic inflammation in severe COVID-19-associated ARDS: a prospective single-center analysis |
| title_sort | predictive markers related to local and systemic inflammation in severe covid 19 associated ards a prospective single center analysis |
| topic | COVID-19 ICU TLR3 IL-6 IL-8 Carboxyhemoglobin |
| url | https://doi.org/10.1186/s12879-023-07980-z |
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