Accelerate lung repair in SARS‐CoV‐2 pneumonia is essential for pandemic handling. Innate lymphoid cells (ILCs) are likely players, given their role in mucosal protection and tissue homeostasis. We studied ILC subpopulations at two time points in a cohort of patients admitted in the hospital due to SARS‐CoV‐2 infection. COVID‐19 patients with moderate/severe respiratory failure featured profound depletion of circulating ILCs at hospital admission, in agreement with overall lymphocyte depletion. However, ILCs recovered in direct correlation with lung function improvement as measured by oxygenation index and in negative association with inflammatory and lung/endothelial damage markers like RAGE. While both ILC1 and ILC2 expanded, ILC2 showed the most striking phenotype changes, with CCR10 upregulation in strong correlation with these parameters. Overall, CCR10 + ILC2 emerge as relevant contributors to SARS‐CoV‐2 pneumonia recovery.
Objective
To analyze and compare COVID-19 patient characteristics, clinical management
and outcomes between the peak and plateau periods of the first pandemic wave
in Portugal.
Methods
This was a multicentric ambispective cohort study including consecutive
severe COVID-19 patients between March and August 2020 from 16 Portuguese
intensive care units. The peak and plateau periods, respectively, weeks 10 -
16 and 17 - 34, were defined.
Results
Five hundred forty-one adult patients with a median age of 65 [57 - 74]
years, mostly male (71.2%), were included. There were no significant
differences in median age (p = 0.3), Simplified Acute Physiology Score II
(40
versus
39; p = 0.8), partial arterial oxygen
pressure/fraction of inspired oxygen ratio (139
versus
136;
p = 0.6), antibiotic therapy (57%
versus
64%; p = 0.2) at
admission, or 28-day mortality (24.4%
versus
22.8%; p =
0.7) between the peak and plateau periods. During the peak period, patients
had fewer comorbidities (1 [0 - 3]
versus
2 [0 - 5]; p =
0.002) and presented a higher use of vasopressors (47%
versus
36%; p < 0.001) and invasive mechanical
ventilation (58.1
versus
49.2%; p < 0.001) at admission,
prone positioning (45%
versus
36%; p = 0.04), and
hydroxychloroquine (59%
versus
10%; p < 0.001) and
lopinavir/ritonavir (41%
versus
10%; p < 0.001)
prescriptions. However, a greater use of high-flow nasal cannulas (5%
versus
16%, p < 0.001) on admission, remdesivir
(0.3%
versus
15%; p < 0.001) and corticosteroid (29%
versus
52%, p < 0.001) therapy, and a shorter ICU
length of stay (12 days
versus
8, p < 0.001) were
observed during the plateau.
Conclusion
There were significant changes in patient comorbidities, intensive care unit
therapies and length of stay between the peak and plateau periods of the
first COVID-19 wave.
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