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. 2022 May 24;11(11):2951.
doi: 10.3390/jcm11112951.

Cytokine Profiles as Potential Prognostic and Therapeutic Markers in SARS-CoV-2-Induced ARDS

Francesco Salton  1   2 , Paola Confalonieri  1   2 , Giuseppina Campisciano  3 , Rossella Cifaldi  1 , Clara Rizzardi  2   4 , Daniele Generali  2   4 , Riccardo Pozzan  1   2 , Stefano Tavano  1   2 , Chiara Bozzi  1   2 , Giulia Lapadula  1   2 , Gianfranco Umberto Meduri  5 , Marco Confalonieri  1   2 , Manola Comar  2   3 , Selene Lerda  6 , Barbara Ruaro  1   2
Affiliations

Cytokine Profiles as Potential Prognostic and Therapeutic Markers in SARS-CoV-2-Induced ARDS

Francesco Salton et al. J Clin Med. .

Abstract

Background: Glucocorticoids (GCs) have been shown to reduce mortality and the need for invasive mechanical ventilation (IMV) in SARS-CoV-2-induced acute respiratory distress syndrome (ARDS). It has been suggested that serum cytokines levels are markers of disease severity in ARDS, although there is only limited evidence of a relationship between the longitudinal cytokine profile and clinical outcomes in patients with SARS-CoV-2-induced ARDS treated with GC.

Methods: We conducted a single-center observational study to investigate serial plasma cytokine levels in 17 patients supported with non-invasive ventilation (NIV) in order to compare the response in five patients who progressed to IMV versus 12 patients who continued with NIV alone. All patients received methylprednisolone 80 mg/day continuous infusion until clinical improvement.

Results: The study groups were comparable at baseline. All patients survived. Although IL-6 was higher in the NIV group at baseline, several cytokines were significantly higher in the IMV group on day 7 (IL-6, IL-8, IL-9, G-CSF, IP-10, MCP-1, MIP-1α) and 14 (IL-6, IL-8, IL-17, G-CSF, MIP-1α, RANTES). No significant differences were observed between groups on day 28.

Conclusions: Patients in the IMV group had higher inflammation levels at intubation than the NIV group, which may indicate a higher resistance to glucocorticoids. Higher GC doses or a longer treatment duration in these patients might have allowed for a better control of inflammation and a better outcome. Further studies are required to define the prognostic value of cytokine patterns, in terms of both GC treatment tailoring and timely initiation of IMV.

Keywords: COVID-19; acute respiratory distress syndrome (ARDS); cytokines; glucocorticoids; non-invasive ventilation (NIV).

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
C-reactive protein time-course (mg/L) showing significantly higher levels in the IMV group only at day 7 (* p-value of Wilcoxon rank-sum test = 0.002).
Figure 2
Figure 2
Serum cytokines levels (pg/mL) at different timepoints in NIV and IMV groups. IL-6 was significantly higher in the NIV group on day 0. IL-6, IL-8, IL-9, G-CSF, IP-10, MCP-1, and MIP-1α showed higher levels in the IMV group on day 7. IL-6, IL-8, IL-17, G-CSF, MIP-1α, and RANTES were higher in the same group on day 14. Note that IL-8 and G-CSF were higher at both days 7 and 14. * indicates statistical significance, p-value < 0.05.
See this image and copyright information in PMC

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