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. 2021 May:106:155-159.
doi: 10.1016/j.ijid.2021.03.066. Epub 2021 Mar 26.

Circulating activated neutrophils in COVID-19: An independent predictor for mechanical ventilation and death

David Dennison  1 , Murtadha Al Khabori  2 , Sahimah Al Mamari  3 , Allan Aurelio  4 , Houda Al Hinai  5 , Khuloud Al Maamari  6 , Jalila Alshekaili  7 , Ghalib Al Khadouri  8
Affiliations

Circulating activated neutrophils in COVID-19: An independent predictor for mechanical ventilation and death

David Dennison et al. Int J Infect Dis. 2021 May.

Abstract

Objectives: Critical illness in COVID-19 is attributed to an exaggerated host immune response. Since neutrophils are the major component of innate immunity, we hypothesize that the quantum of activated neutrophils in the blood may predict an adverse outcome.

Design: In a retrospective study of 300 adult patients with confirmed COVID-19, we analyzed the impact of neutrophil activation (NEUT-RI), interleukin-6 (IL-6) and the established clinical risk factors of age, diabetes, obesity and hypertension on the clinical outcome.

Results: Significant predictors of the need for mechanical ventilation were NEUT-RI (Odds Ratio (OR) = 1.22, P < 0.001), diabetes (OR = 2.56, P = 0.00846) and obesity (OR = 6.55, P < 0.001). For death, the significant predictors were NEUT-RI (OR = 1.14, P = 0.00432), diabetes (OR = 4.11, P = 0.00185) and age (OR = 1.04, P = 0.00896). The optimal cut-off value for NEUT-RI to predict mechanical ventilation and death was 52 fluorescence intensity units (sensitivity 44%, specificity 88%, area under the curve 0.67 and 44%, 86%, 0.64, respectively).

Conclusion: This finding supports an aberrant neutrophil response in COVID-19, likely due to uncontained viral replication, tissue hypoxia and exacerbated inflammation, introduces a novel biomarker for rapid monitoring and opens new avenues for therapeutic strategies.

Keywords: Aberrant neutrophil response; Activated neutrophils; Biomarker; COVID-19; Critical illness; Innate immunity.

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Figures

Figure 1
Figure 1
Correlation Matrix. The above figure represents the correlation matrix of the laboratory parameters for the included patients. The circle’s size represents the strength of the correlation, while the color represents the strength and direction of the correlation. IG: immature granulocytes, WBC: white blood cells, nRBC: nucleated red blood cells, AS-Lymph: antibody-synthesizing lymphocytes, RE-Lymph: reactive lymphocytes, NEUT-GI: neutrophil granularity intensity, NEUT-RI: neutrophil reactivity intensity, IL-6: interleukin-6.
See this image and copyright information in PMC

References

    1. Barnes B.J., Androver J.M., Baxter-Stolzfus A., Borczuk A., Cools-Lartigue J., Crawford J.M. Targeting potential drivers of COVID-19: neutrophil extracellular traps. J Exp Med. 2020;217(6):1–7. - PMC - PubMed
    1. Colom B., Bodkin J.V., Beyrau M., Woodfin A., Ody C., Rourke C. Leukotriene B4-neutrophil elastase axis drives neutrophil reverse transendothelial cell migration in vivo. Immunity. 2015;42(6):1075–1086. - PMC - PubMed
    1. Egners A., Erdem M., Cramer T. The response of macrophages and neutrophils to hypoxia in the context of cancer and other inflammatory diseases. Mediat Inflamm. 2016;2016 - PMC - PubMed
    1. Eltzschig H.K. Targeting hypoxia-induced inflammation. Anesthesiology. 2011;114(2):239–242. - PMC - PubMed
    1. Eltzschig H.K., Carmeliet P. Hypoxia and inflammation. N Engl J Med. 2011;364(7):656–665. - PMC - PubMed