Association of elevated inflammatory markers and severe COVID-19

Pan, Jianji; Zhu, Jieyun; Zhong, Zhimei; Li, Hongyuan; Pang, Jielong; Li, Bocheng; Zhang, Jianfeng

doi:10.1097/md.0000000000023315

Cited by 161 publications

(164 citation statements)

References 36 publications

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“…The immune response elicited by the viral infection has been associated with a hypercatabolic state similar to that seen in patients with rhabdomyolysis or tumor-lysis syndrome. Skeletal muscles loss has been linked to pro-inflammatory cytokines such as IL-6 and TNF-α [ 75 , 76 ], which are elevated during COVID-19 and correlate with disease severity [ 77 ]. A small case series from Mount Sinai Hospital in New York City reported nine critically ill patients with COVID-19-related AKI who had evidence of hyper catabolism characterized by high serum phosphorus and blood urea nitrogen (BUN), hyperkalemia, and hypocalcemia.…”

Section: Clinical Characteristics Of Cov-akimentioning

confidence: 99%

COVID-19 and the Kidney: A Worrisome Scenario of Acute and Chronic Consequences

Sanchez-Russo

Billah

Chancay

et al. 2021

JCM

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Acute kidney injury (AKI) is a common finding in patients with coronavirus disease 2019 (COVID-19) and has been associated with higher rates of death when compared to COVID-19 patients without kidney injury. Whereas the definitive pathogenesis of COVID-19-related AKI (CoV-AKI) is not clear, histopathologic evidence seems to point at multiple etiologies for the disease, including indirect and direct viral kidney injury. The high incidence of CoV-AKI, along with the aggressive clinical presentation of this entity, have increased the demands for kidney replacement therapies, rapidly overwhelming the supplies of healthcare systems even in major tertiary care centers. As a result, nephrologists have come up with alternatives to maximize the efficiency of treatments and have developed non-conventional therapeutic alternatives such as the implementation of acute peritoneal dialysis for critically ill patients. The long-term implications of CoV-AKI are yet unknown, though early studies suggest that around one third of the patients who survive will remain dependent on kidney replacement therapy. Nephrologists and healthcare workers need to be familiar with the clinical presentation and therapeutic challenges of CoV-AKI in order to develop strategies to mitigate the burden of the disease for patients, and for services providing kidney replacement therapies.

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Section: Clinical Characteristics Of Cov-akimentioning

confidence: 99%

COVID-19 and the Kidney: A Worrisome Scenario of Acute and Chronic Consequences

Sanchez-Russo

Billah

Chancay

et al. 2021

JCM

View full text Add to dashboard Cite

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“…It is evident that augmented levels of IL-6 were observed in patients infected with SARS-CoV-2 and correlated with disease severity (Zhang, Peihua et al, 2020; Aziz et al, 2020 ; Mojtabavi et al, 2020 ; Ji et al, 2020 ; Udomsinprasert et al, 2020 ). Levels of IL-6 seem to be associated with inflammatory response, respiratory failure, needing for mechanical ventilation and/or intubation and mortality in COVID-19 patients ( Herold et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Recent updates in the clinical trials of therapeutic monoclonal antibodies targeting cytokine storm for the management of COVID-19

Patel

Saxena

Mehta

2021

Heliyon

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Clinical studies have identified a cytokine storm in the third stage of disease progression in critical ill patients with coronavirus disease 2019 . Hence, effectively suppressing the uncontrolled immune response of the host towards the invaded viruses in a cytokine storm is a critical step to prevent the deterioration of patient conditions and decrease the rate of mortality. Therapeutic monoclonal antibodies (mAbs) are found to be effective for the management of acute respiratory distress syndrome in patients with COVID-19. In this review, we compiled all therapeutic mAbs targeting cytokine storm, which are in clinical trials for its repurposing in the management of COVID-19. Compilation of clinical trial data indicated that therapeutic monoclonal antibodies targeting interleukins (IL-6, IL-1ra, IL-8, IL-1β, IL-17A, IL-33), interferon-gamma, tumor necrosis factor-alpha, Pselectin, connective tissue growth factor, plasma kallikrein, tumor necrosis factor superfamily 14, granulocyte macrophage colony stimulating factor, colony stimulating factor 1 receptor, C-C chemokine receptor type 5, cluster of differentiation 14 and 147, vascular endothelial growth factor, programmed cell death protein-1, Angiopoietin -2, human factor XIIa, complementary protein 5, natural killer cell receptor G2A, human epidermal growth factor receptor 2, immunoglobulin-like transcript 7 receptor, complement component fragment 5a receptor and viral attachment to the human cell were under investigation for management of severely ill patients with COVID-19. Among these, about 65 clinical trials are targeting IL-6 inhibition as the most promising one and Tocilizumab, an IL-6 inhibitor is considered to be the potential candidate to treat cytokine storm associated with the COVID-19. OverviewCoronavirus disease 2019 (COVID-19) is the infectious disease, which affects primarily the lungs, caused by newly identified coronavirus termed as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patient infected with SARS-CoV-2 was initially discovered at Wuhan, China in December 2019 and is still spreading across the globe (Singhal, 2020). The COVID-19 outbreak was declared as pandemic on March 11, 2020 by the world health organization (WHO) (Coperchini et al., 2020). By September 9, 2020 the number of deaths raised to 896K amongst 27.5 million confirmed cases of COVID-19. The majority of the patients infected with SARS-CoV-2 in this COVID-19 pandemic are clinically asymptomatic or develop mild clinical manifestations like cough, mild fever, or muscle soreness. However, nearly 10-20% of patients (especially geriatric and patients with other co-morbidity) will develop pneumonia and acute respiratory distress syndrome (ARDS) (Soy et al., 2020). This COVID-19 pandemic created global crises of both public health as well as economic and thus emerged the need for rapid development of vaccines and therapeutic countermeasures (Sempowski et al., 2020). One approach for finding appropriate therapeutics for treating COVID-19 is rapid repurposing of existin...

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“…In particular, we dichotomized the continuous variables above/below the median and summed for each patient the single variables in order to have a score that could assume values from 0 (low risk) to 10 (high risk) (CLINICAL). To this, we added as variable for multivariate analysis the Total affected lung V% (VOLUME) and Systemic Inflammatory response Index as a surrogate of all laboratory test included in the manuscript (calculated by: platelet counts × neutrophil counts/lymphocyte counts) (INFLA) as suggested by recent publications to be a remarkable prognostic indicator to assess the in-hospital mortality and the development of respiratory complications in patients with COVID-19 [ 11 , 12 ]. The performance of the predictive models, singles and composite (MODEL 1 including all clinical, laboratory and CT variables) were assessed using receiver operating characteristic analysis (ROC), and the area under the curve (AUC) values were compared using the DeLong test.…”

Section: Methodsmentioning

confidence: 99%

Quantitative Evaluation of COVID-19 Pneumonia Lung Extension by Specific Software and Correlation with Patient Clinical Outcome

et al. 2021

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Lung infection named as COVID-19 is an infectious disease caused by the most recently discovered coronavirus 2 (SARS-CoV-2). CT (computed tomography) has been shown to have good sensitivity in comparison with RT-PCR, particularly in early stages. However, CT findings appear to not always be related to a certain clinical severity. The aim of this study is to evaluate a correlation between the percentage of lung parenchyma volume involved with COVID-19 infection (compared to the total lung volume) at baseline diagnosis and correlated to the patient’s clinical course (need for ventilator assistance and or death). All patients with suspected COVID-19 lung disease referred to our imaging department for Chest CT from 24 February to 6 April 2020were included in the study. Specific CT features were assessed including the amount of high attenuation areas (HAA) related to lung infection. HAA, defined as the percentage of lung parenchyma above a predefined threshold of −650 (HAA%, HAA/total lung volume), was automatically calculated using a dedicated segmentation software. Lung volumes and CT findings were correlated with patient’s clinical course. Logistic regressions were performed to assess the predictive value of clinical, inflammatory and CT parameters for the defined outcome. In the overall population we found an average infected lung volume of 31.4 ± 26.3% while in the subgroup of patients who needed ventilator assistance and who died as well as the patients who died without receiving ventilator assistance the volume of infected lung was significantly higher 41.4 ± 28.5 and 72.7 ± 36.2 (p < 0.001). In logistic regression analysis best predictors for ventilation and death were the presence of air bronchogram (p = 0.006), crazy paving (p = 0.007), peripheral distribution (p < 0.001), age (p = 0.002), fever at admission (p = 0.007), dyspnea (p = 0.002) and cardiovascular comorbidities (p < 0.001). In multivariable analysis, quantitative CT parameters and features added incremental predictive value beyond a model with only clinical parameters (area under the curve, 0.78 vs. 0.74, p = 0.02). Our study demonstrates that quantitative evaluation of lung volume involved by COVID-19 pneumonia helps to predict patient’s clinical course.

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Association of elevated inflammatory markers and severe COVID-19

Cited by 161 publications

References 36 publications

COVID-19 and the Kidney: A Worrisome Scenario of Acute and Chronic Consequences

COVID-19 and the Kidney: A Worrisome Scenario of Acute and Chronic Consequences

Recent updates in the clinical trials of therapeutic monoclonal antibodies targeting cytokine storm for the management of COVID-19

Quantitative Evaluation of COVID-19 Pneumonia Lung Extension by Specific Software and Correlation with Patient Clinical Outcome

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