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Kidd KO, Williams AH, Taylor A, Martin L, Robins V, Sayer JA, Olinger E, Mabillard HR, Papagregoriou G, Deltas C, Stavrou C, Conlon PJ, Hogan RE, Elhassan EAE, Springer D, Zima T, Izzi C, Vrbacká A, Piherová L, Pohludka M, Radina M, Vylet'al P, Hodanova K, Zivna M, Kmoch S, Bleyer AJ. Eight-Fold Increased COVID-19 Mortality in Autosomal Dominant Tubulointerstitial Kidney Disease due to MUC1 Mutations: An Observational Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.07.03.24309887. [PMID: 39006416 PMCID: PMC11245082 DOI: 10.1101/2024.07.03.24309887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Background MUC1 and UMOD pathogenic variants cause autosomal dominant tubulointerstitial kidney disease (ADTKD). MUC1 is expressed in kidney, nasal mucosa and respiratory tract, while UMOD is expressed only in kidney. Due to haplo-insufficiency ADTKD- MUC1 patients produce approximately 50% of normal mucin-1. Methods To determine whether decreased mucin-1 production was associated with an increased COVID-19 risk, we sent a survey to members of an ADTKD registry in September 2021, after the initial, severe wave of COVID-19. We linked results to previously obtained ADTKD genotype and plasma CA15-3 (mucin-1) levels and created a longitudinal registry of COVID-19 related deaths. Results Surveys were emailed to 637 individuals, with responses from 89 ADTKD- MUC1 and 132 ADTKD- UMOD individuals. 19/83 (23%) ADTKD- MUC1 survey respondents reported a prior COVID-19 infection vs. 14/125 (11%) ADTKD- UMOD respondents (odds ratio (OR) 2.35 (95%CI 1.60-3.11, P = 0.0260). Including additional familial cases reported from survey respondents, 10/41 (24%) ADTKD- MUC1 individuals died of COVID-19 vs. 1/30 (3%) with ADTKD- UMOD , with OR 9.21 (95%CI 1.22-69.32), P = 0.03. The mean plasma mucin-1 level prior to infection in 14 infected and 27 uninfected ADTKD- MUC1 individuals was 7.06±4.12 vs. 10.21±4.02 U/mL ( P = 0.035). Over three years duration, our longitudinal registry identified 19 COVID-19 deaths in 360 ADTKD- MUC1 individuals (5%) vs. 3 deaths in 478 ADTKD- UMOD individuals (0.6%) ( P = 0.0007). Multivariate logistic regression revealed the following odds ratios (95% confidence interval) for COVID-19 deaths: ADTKD- MUC1 8.4 (2.9-29.5), kidney transplant 5.5 (1.6-9.1), body mass index (kg/m 2 ) 1.1 (1.0-1.2), age (y) 1.04 (1.0-1.1). Conclusions Individuals with ADTKD- MUC1 are at an eight-fold increased risk of COVID-19 mortality vs. ADTKD- UMOD individuals. Haplo-insufficient production of mucin-1 may be responsible.
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Zou J, Shi Y, Xue S, Jiang H. Use of serum KL-6 and chest radiographic severity grade to predict 28-day mortality in COVID-19 patients with pneumonia: a retrospective cohort study. BMC Pulm Med 2024; 24:187. [PMID: 38637771 PMCID: PMC11027533 DOI: 10.1186/s12890-024-02992-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/02/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has had a global social and economic impact. An easy assessment procedure to handily identify the mortality risk of inpatients is urgently needed in clinical practice. Therefore, the aim of this study was to develop a simple nomogram model to categorize patients who might have a poor short-term outcome. METHODS A retrospective cohort study of 189 COVID-19 patients was performed at Shanghai Ren Ji Hospital from December 12, 2022 to February 28, 2023. Chest radiography and biomarkers, including KL-6 were assessed. Risk factors of 28-day mortality were selected by a Cox regression model. A nomogram was developed based on selected variables by SMOTE strategy. The predictive performance of the derived nomogram was evaluated by calibration curve. RESULTS In total, 173 patients were enrolled in this study. The 28-day mortality event occurred in 41 inpatients (23.7%). Serum KL-6 and radiological severity grade (RSG) were selected as the final risk factors. A nomogram model was developed based on KL-6 and RSG. The calibration curve suggested that the nomogram model might have potential clinical value. The AUCs for serum KL-6, RSG, and the combined score in the development group and validation group were 0.885 (95% CI: 0.804-0.952), 0.818 (95% CI: 0.711-0.899), 0.868 (95% CI: 0.776-0.942) and 0.932 (95% CI: 0.862-0.997), respectively. CONCLUSIONS Our results suggested that the nomogram based on KL-6 and RSG might be a potential method for evaluating 28-day mortality in COVID-19 patients. A high combined score might indicate a poor outcome in COVID-19 patients with pneumonia.
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Affiliation(s)
- Jing Zou
- Department of Respirology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No.160 Pujian Rd, 200127, Shanghai, China
| | - Yiping Shi
- Department of Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shan Xue
- Department of Respirology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No.160 Pujian Rd, 200127, Shanghai, China
| | - Handong Jiang
- Department of Respirology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No.160 Pujian Rd, 200127, Shanghai, China.
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Mendes-Filho SPDM, de Souza Pinheiro R, Martins FS, Giroldi PJ, e Melo RH, de Oliveira EL, dos Santos AB, Medeiros DCO, Lopes JA, Chaves YO, Zuliani JP, Nogueira PA. Kinetics of IL-6, C-reactive Protein and Fibrinogen Levels in COVID-19 Outpatients Who Evolved to Hypoxemia. CLINICAL PATHOLOGY (THOUSAND OAKS, VENTURA COUNTY, CALIF.) 2024; 17:2632010X231222795. [PMID: 38188270 PMCID: PMC10768631 DOI: 10.1177/2632010x231222795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024]
Abstract
Introduction Despite the efficacy of the COVID-19, the search for improvements in the management of severe/critical cases continues to be important. The aim is to demonstrate the kinetics of 4 serological markers in patients with COVID-19 who evolved in hypoxemia. Methods From June to December 2020, the Health Secretariat of Rondônia State, Brazil, established a home medical care service team (HMCS) that provided clinical follow-up for health professionals and military personnel with COVID-19. The clinical and laboratory monitoring was individualized at home by a nursing and medical team. In addition to laboratory parameters, C-reactive protein (CRP), interleukin-6 (IL-6), fibrinogen, and D-dimer levels were periodically taken to monitor the evolution of treatment. Results Of 218 patients telemonitored, 48 patients needed special care by the HMCS team due to shortness of breath. Chest tomography showed multiple ground-glass shadows and lung parenchymal condensations that was compatible with secondary bacterial infection associated with leukocytosis, for which antibiotics were prescribed. The symptoms were accompanied by increases of CRP and IL-6 levels followed by fibrinogen after a few days, for which an anticoagulant therapy was included. Thirty-three patients evolved to improvements in clinical signs and laboratory results. Between the sixth and eighth day of illness, 15 patients presented signs of hypoxemia with low O2 saturation accompanied with an increase in the respiratory rate, with some of them requiring oxygen therapy. As they did not present signs of clinical severity, but their laboratory markers showed an abrupt IL-6 peak that was higher than the increase in CRP and a new alteration in fibrinogen levels, they received a supplemental dose of anticoagulant and a high dose of corticosteroids, which resulted in clinical improvement. Conclusion Our study demonstrates that monitoring of IL-6 and CRP may identify precocious hypoxemia in COVID-19 patients and prevented the progressive deterioration of the lung injury.
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Affiliation(s)
| | - Rebeca de Souza Pinheiro
- Programa de Pós-graduação de Imunologia Básica e Aplicada, Universidade Federal do Amazonas, Manaus/AM, Brazil
| | - Fernanda Simão Martins
- Serviço de Assistência Médica Domiciliar (SAMD), Secretaria Estadual da Saúde (SESAU), Porto Velho/RO, Brazil
| | - Paulo Jose Giroldi
- Laboratório Estadual de Patologia e Análises Clínicas (LEPAC), Porto Velho/RO, Brazil
| | - Raul Honorato e Melo
- Serviço de Assistência Médica Domiciliar (SAMD), Secretaria Estadual da Saúde (SESAU), Porto Velho/RO, Brazil
- Hospital Cemetron, Porto Velho/RO, Brazil
| | | | - Anibal Borin dos Santos
- Serviço de Assistência Médica Domiciliar (SAMD), Secretaria Estadual da Saúde (SESAU), Porto Velho/RO, Brazil
| | | | | | - Yury Oliveira Chaves
- Instituto Leônidas e Maria Deane (ILMD), Fundação Oswaldo Cruz – Amazonas (FIOCRUZ – AMAZONAS), Manaus/AM, Brazil
| | | | - Paulo Afonso Nogueira
- Programa de Pós-graduação de Imunologia Básica e Aplicada, Universidade Federal do Amazonas, Manaus/AM, Brazil
- Instituto Leônidas e Maria Deane (ILMD), Fundação Oswaldo Cruz – Amazonas (FIOCRUZ – AMAZONAS), Manaus/AM, Brazil
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus/AM, Brazil
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Letellier A, Rolland-Debord C, Luque-Paz D, Milon A, Choinier P, Blin E, Halitim P, Bravais J, Lefèvre G, Parrot A, Piéroni L, Cadranel J. Prognostic value of serum Krebs von den Lungen-6 (KL-6) levels in COVID-19 pneumonia. Respir Med Res 2023; 84:101054. [PMID: 37897878 DOI: 10.1016/j.resmer.2023.101054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 07/23/2023] [Accepted: 09/30/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND AND OBJECTIVES Krebs von den Lungen-6 (KL-6), expressed by damaged type II pneumocytes, is useful in the diagnosis and severity assessment of many diffuse interstitial lung diseases. The objective of our study was to determine the prognostic value of the initial KL-6 plasma level in COVID-19 pneumonia. METHODS All patients hospitalized for a suspected COVID-19 pneumonia between March and May 2020 in our Chest department of a French university hospital were included. KL-6 serum concentrations were measured within 72 h of diagnostic suspicion by chemiluminescence enzyme immunoassay Survival analysis was performed using a Cox regression and modeled by a Kaplan-Meier curve. RESULTS Sixty-six COVID-19 patients (average age = 64 ± 14 years, 71.2 % males) with KL-6 serum measurement were included. Median KL-6 serum concentration was 409 ± 312 U/mL. KL-6 was significantly higher in men (p = 0.003), elders (p = 0.0001) and in patients with greater Charlson's score (p = 0.002). Higher KL-6 concentration was significantly associated with in-hospital mortality (HR: 8.66; 95 % CI:1.1-69.2, p = 0.014), radiological extension of lesions on chest CT scan (p = 0.004) and higher WHO severity score (p = 0.042), but not with admission in intensive care unit. In 9 (14 %) non-surviving COVID-19 patients, KL-6 serum concentration increased whereas it remained stable or decreased in survivors. At 3 months follow-up (n = 48), DLCO was negatively correlated with the initial KL-6 value (r = 0.47, p = 0.001), while FVC, FEV1 and MRC score were not. CONCLUSION Initial KL-6 serum concentration is significantly associated with in-hospital mortality, unfavorable outcome, and persistent impairment of DLCO at 3 months. Initial KL-6 plasma determination appears as a prognostic biomarker in COVID-19 pneumonia.
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Affiliation(s)
- Alice Letellier
- Department of Pulmonology and Thoracic Oncology, AP-HP Tenon Hospital, Sorbonne University, 4 rue de la Chine, 75920 Paris, France
| | - Camille Rolland-Debord
- Department of Pulmonology and Thoracic Oncology, AP-HP Tenon Hospital, Sorbonne University, 4 rue de la Chine, 75920 Paris, France
| | - David Luque-Paz
- Department of Infectious Diseases and Intensive Care Unit, Pontchaillou Hospital, CHU Rennes, 2 rue Henri Guilloux, 35000 Rennes, France
| | - Audrey Milon
- Radiology Department, AP-HP Tenon Hospital, Sorbonne University, 4 rue de la Chine,75920 Paris, France
| | - Pascaline Choinier
- Department of Pulmonology and Thoracic Oncology, AP-HP Tenon Hospital, Sorbonne University, 4 rue de la Chine, 75920 Paris, France
| | - Emmanuelle Blin
- Department of Pulmonology and Thoracic Oncology, AP-HP Tenon Hospital, Sorbonne University, 4 rue de la Chine, 75920 Paris, France
| | - Pierre Halitim
- Department of Pulmonology and Thoracic Oncology, AP-HP Tenon Hospital, Sorbonne University, 4 rue de la Chine, 75920 Paris, France
| | - Juliette Bravais
- Department of Pulmonology and Thoracic Oncology, AP-HP Tenon Hospital, Sorbonne University, 4 rue de la Chine, 75920 Paris, France
| | - Guillaume Lefèvre
- Biochemistry Department, AP-HP Tenon Hospital, Sorbonne University, 4 rue de la Chine, 75920 Paris, France
| | - Antoine Parrot
- Department of Pulmonology and Thoracic Oncology, AP-HP Tenon Hospital, Sorbonne University, 4 rue de la Chine, 75920 Paris, France
| | - Laurence Piéroni
- Biochemistry Department, AP-HP Tenon Hospital, Sorbonne University, 4 rue de la Chine, 75920 Paris, France
| | - Jacques Cadranel
- Department of Pulmonology and Thoracic Oncology, AP-HP Tenon Hospital, Sorbonne University, 4 rue de la Chine, 75920 Paris, France.
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Macklin M, Thompson C, Kawano-Dourado L, Bauer Ventura I, Weschenfelder C, Trostchansky A, Marcadenti A, Tighe RM. Linking Adiposity to Interstitial Lung Disease: The Role of the Dysfunctional Adipocyte and Inflammation. Cells 2023; 12:2206. [PMID: 37759429 PMCID: PMC10526202 DOI: 10.3390/cells12182206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/19/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
Adipose tissue has functions beyond its principal functions in energy storage, including endocrine and immune functions. When faced with a surplus of energy, the functions of adipose tissue expand by mechanisms that can be both adaptive and detrimental. These detrimental adipose tissue functions can alter normal hormonal signaling and promote local and systemic inflammation with wide-ranging consequences. Although the mechanisms by which adipose tissue triggers metabolic dysfunction and local inflammation have been well described, little is known about the relationship between adiposity and the pathogenesis of chronic lung conditions, such as interstitial lung disease (ILD). In this review, we detail the conditions and mechanisms by which adipose tissue becomes dysfunctional and relate this dysfunction to inflammatory changes observed in various forms of ILD. Finally, we review the existing basic and clinical science literature linking adiposity to ILD, highlighting the need for additional research on the mechanisms of adipocyte-mediated inflammation in ILD and its clinical implications.
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Affiliation(s)
- Michael Macklin
- Section of Rheumatology, The University of Chicago, Chicago, IL 60637, USA;
| | - Chelsea Thompson
- Section of Rheumatology, The University of Chicago, Chicago, IL 60637, USA;
| | - Leticia Kawano-Dourado
- Hcor Research Institute (IP-Hcor), Hcor, São Paulo 04004-050, Brazil; (L.K.-D.); (A.M.)
- Pulmonary Division, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo 05403-903, Brazil
| | | | - Camila Weschenfelder
- Graduate Program in Health Sciences (Cardiology), Cardiology Institute, University Foundation of Cardiology (IC/FUC), Porto Alegre 90050-170, Brazil;
| | - Andrés Trostchansky
- Department of Biochemistry and Biomedical Research Center, School of Medicine, University of the Republic, Montevideo 11800, Uruguay;
| | - Aline Marcadenti
- Hcor Research Institute (IP-Hcor), Hcor, São Paulo 04004-050, Brazil; (L.K.-D.); (A.M.)
- Graduate Program in Health Sciences (Cardiology), Cardiology Institute, University Foundation of Cardiology (IC/FUC), Porto Alegre 90050-170, Brazil;
- Graduate Program in Epidemiology, School of Public Health, University of São Paulo (FSP-USP), São Paulo 01246-904, Brazil
| | - Robert M. Tighe
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, NC 27710, USA;
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Duong-Quy S, Vo-Pham-Minh T, Tran-Xuan Q, Huynh-Anh T, Vo-Van T, Vu-Tran-Thien Q, Nguyen-Nhu V. Post-COVID-19 Pulmonary Fibrosis: Facts-Challenges and Futures: A Narrative Review. Pulm Ther 2023; 9:295-307. [PMID: 37209374 PMCID: PMC10199290 DOI: 10.1007/s41030-023-00226-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/19/2023] [Indexed: 05/22/2023] Open
Abstract
Patients with coronavirus disease 2019 (COVID-19) usually suffer from post-acute sequelae of coronavirus disease 2019 (PASC). Pulmonary fibrosis (PF) has the most significant long-term impact on patients' respiratory health, called post-COVID-19 pulmonary fibrosis (PC19-PF). PC19- PF can be caused by acute respiratory distress syndrome (ARDS) or pneumonia due to COVID-19. The risk factors of PC19-PF, such as older age, chronic comorbidities, the use of mechanical ventilation during the acute phase, and female sex, should be considered. Individuals with COVID-19 pneumonia symptoms lasting at least 12 weeks following diagnosis, including cough, dyspnea, exertional dyspnea, and poor saturation, accounted for nearly all disease occurrences. PC19-PF is characterized by persistent fibrotic tomographic sequelae associated with functional impairment throughout follow-up. Thus, clinical examination, radiology, pulmonary function tests, and pathological findings should be done to diagnose PC19-PF patients. PFT indicated persistent limitations in diffusion capacity and restrictive physiology, despite the absence of previous testing and inconsistency in the timeliness of assessments following acute illness. It has been hypothesized that PC19-PF patients may benefit from idiopathic pulmonary fibrosis treatment to prevent continued infection-related disorders, enhance the healing phase, and manage fibroproliferative processes. Immunomodulatory agents might reduce inflammation and the length of mechanical ventilation during the acute phase of COVID-19 infection, and the risk of the PC19-PF stage. Pulmonary rehabilitation, incorporating exercise training, physical education, and behavioral modifications, can improve the physical and psychological conditions of patients with PC19-PF.
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Affiliation(s)
- Sy Duong-Quy
- Clinical Research Unit, Lam Dong Medical College and Bio-Medical Research Centre, Dalat, Vietnam
- Immuno-Allergology Division, Hershey Medical Center, Penn State Medical College, State College, PA, USA
- Outpatient Department, Pham Ngoc Thach Medical University, Ho Chi Minh City, Vietnam
- Department of Respiratory Functional Exploration, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Thu Vo-Pham-Minh
- Department of Internal Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Quynh Tran-Xuan
- Department of Internal Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Tuan Huynh-Anh
- Department of Respiratory Diseases, Hoan My Cuu Long Hospital, Can Tho, Vietnam
| | - Tinh Vo-Van
- Outpatient Department, Pham Ngoc Thach Medical University, Ho Chi Minh City, Vietnam
| | - Quan Vu-Tran-Thien
- Department of Respiratory Functional Exploration, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Vinh Nguyen-Nhu
- Department of Respiratory Functional Exploration, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
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Lassan S, Tesar T, Tisonova J, Lassanova M. Pharmacological approaches to pulmonary fibrosis following COVID-19. Front Pharmacol 2023; 14:1143158. [PMID: 37397477 PMCID: PMC10308083 DOI: 10.3389/fphar.2023.1143158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
Background: In the past few years, COVID-19 became the leading cause of morbidity and mortality worldwide. Although the World Health Organization has declared an end to COVID-19 as a public health emergency, it can be expected, that the emerging new cases at the top of previous ones will result in an increasing number of patients with post-COVID-19 sequelae. Despite the fact that the majority of patients recover, severe acute lung tissue injury can in susceptible individuals progress to interstitial pulmonary involvement. Our goal is to provide an overview of various aspects associated with the Post-COVID-19 pulmonary fibrosis with a focus on its potential pharmacological treatment options. Areas covered: We discuss epidemiology, underlying pathobiological mechanisms, and possible risk and predictive factors that were found to be associated with the development of fibrotic lung tissue remodelling. Several pharmacotherapeutic approaches are currently being applied and include anti-fibrotic drugs, prolonged use or pulses of systemic corticosteroids and non-steroidal anti-inflammatory and immunosuppressive drugs. In addition, several repurposed or novel compounds are being investigated. Fortunately, clinical trials focused on pharmacological treatment regimens for post-COVID-19 pulmonary fibrosis have been either designed, completed or are already in progress. However, the results are contrasting so far. High quality randomised clinical trials are urgently needed with respect to the heterogeneity of disease behaviour, patient characteristics and treatable traits. Conclusion: The Post-COVID-19 pulmonary fibrosis contributes to the burden of chronic respiratory consequences among survivors. Currently available pharmacotherapeutic approaches mostly comprise repurposed drugs with a proven efficacy and safety profile, namely, corticosteroids, immunosuppressants and antifibrotics. The role of nintedanib and pirfenidone is promising in this area. However, we still need to verify conditions under which the potential to prevent, slow or stop progression of lung damage will be fulfilled.
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Affiliation(s)
- Stefan Lassan
- Department of Pneumology, Phthisiology and Functional Diagnostics, Slovak Medical University and Bratislava University Hospital, Bratislava, Slovakia
| | - Tomas Tesar
- Department of Organisation and Management of Pharmacy, Faculty of Pharmacy, Comenius University, Bratislava, Slovakia
| | - Jana Tisonova
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Monika Lassanova
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
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Azekawa S, Chubachi S, Asakura T, Namkoong H, Sato Y, Edahiro R, Lee H, Tanaka H, Otake S, Nakagawara K, Fukushima T, Watase M, Sakurai K, Kusumoto T, Masaki K, Kamata H, Ishii M, Hasegawa N, Okada Y, Koike R, Kitagawa Y, Kimura A, Imoto S, Miyano S, Ogawa S, Kanai T, Fukunaga K. Serum KL-6 levels predict clinical outcomes and are associated with MUC1 polymorphism in Japanese patients with COVID-19. BMJ Open Respir Res 2023; 10:10/1/e001625. [PMID: 37230764 DOI: 10.1136/bmjresp-2023-001625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Krebs von den Lungen-6 (KL-6) is a known biomarker for diagnosis and monitoring of interstitial lung diseases. However, the role of serum KL-6 and the mucin 1 (MUC1) variant (rs4072037) in COVID-19 outcomes remains to be elucidated. We aimed to evaluate the relationships among serum KL-6 levels, critical outcomes and the MUC1 variant in Japanese patients with COVID-19. METHODS This is a secondary analysis of a multicentre retrospective study using data from the Japan COVID-19 Task Force collected from February 2020 to November 2021, including 2226 patients with COVID-19 whose serum KL-6 levels were measured. An optimal serum KL-6 level cut-off to predict critical outcomes was determined and used for multivariable logistic regression analysis. Furthermore, the relationship among the allele dosage of the MUC1 variant, calculated from single nucleotide polymorphism typing data of genome-wide association studies using the imputation method, serum KL-6 levels and COVID-19 critical outcomes was evaluated. RESULTS Serum KL-6 levels were significantly higher in patients with COVID-19 with critical outcomes (511±442 U/mL) than those without (279±204 U/mL) (p<0.001). Serum KL-6 levels ≥304 U/mL independently predicted critical outcomes (adjusted OR (aOR) 3.47, 95% CI 2.44 to 4.95). Moreover, multivariable logistic regression analysis with age and sex indicated that the MUC1 variant was independently associated with increased serum KL-6 levels (aOR 0.24, 95% CI 0.28 to 0.32) but not significantly associated with critical outcomes (aOR 1.11, 95% CI 0.80 to 1.54). CONCLUSION Serum KL-6 levels predicted critical outcomes in Japanese patients with COVID-19 and were associated with the MUC1 variant. Therefore, serum KL-6 level is a potentially useful biomarker of critical COVID-19 outcomes.
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Affiliation(s)
- Shuhei Azekawa
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine Graduate School of Medicine, Tokyo, Japan
| | - Shotaro Chubachi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine Graduate School of Medicine, Tokyo, Japan
| | - Takanori Asakura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine Graduate School of Medicine, Tokyo, Japan
- Department of Clinical Medicine (Laboratory of Bioregulatory Medicine), Kitasato University School of Pharmacy, Tokyo, Japan
- Department of Respiratory Medicine, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan
| | - Ho Namkoong
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Ryuya Edahiro
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ho Lee
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine Graduate School of Medicine, Tokyo, Japan
| | - Hiromu Tanaka
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine Graduate School of Medicine, Tokyo, Japan
| | - Shiro Otake
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine Graduate School of Medicine, Tokyo, Japan
| | - Kensuke Nakagawara
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine Graduate School of Medicine, Tokyo, Japan
| | - Takahiro Fukushima
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine Graduate School of Medicine, Tokyo, Japan
| | - Mayuko Watase
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine Graduate School of Medicine, Tokyo, Japan
| | - Kaori Sakurai
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine Graduate School of Medicine, Tokyo, Japan
| | - Tatsuya Kusumoto
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine Graduate School of Medicine, Tokyo, Japan
| | - Katsunori Masaki
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine Graduate School of Medicine, Tokyo, Japan
| | - Hirofumi Kamata
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine Graduate School of Medicine, Tokyo, Japan
| | - Makoto Ishii
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine Faculty of Medicine, Nagoya, Japan
| | - Naoki Hasegawa
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Yukinori Okada
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan
- Center for Infectious Disease Education and Research (CiDER), Osaka University, Suita, Japan
- Laboratory for Systems Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Laboratory of Statistical Immunology, Immunology Frontier Research Center (WPI-IFReC), Osaka University, Suita, Japan
- Department of Genome Informatics, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Ryuji Koike
- Medical Innovation Promotion Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Akinori Kimura
- Institute of Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Seiya Imoto
- Division of Health Medical Intelligence, Human Genome Center, the Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Satoru Miyano
- M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Seishi Ogawa
- Department of Pathology and Tumor Biology, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine Graduate School of Medicine, Tokyo, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine Graduate School of Medicine, Tokyo, Japan
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9
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Holton SE, Mitchem M, Pipavath S, Morrell ED, Bhatraju PK, Hamerman JA, Speake C, Malhotra U, Wurfel MM, Ziegler S, Mikacenic C. Mediators of monocyte chemotaxis and matrix remodeling are associated with the development of fibrosis in patients with COVID-19. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.28.23289261. [PMID: 37205332 PMCID: PMC10187320 DOI: 10.1101/2023.04.28.23289261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Acute respiratory distress syndrome (ARDS) has a fibroproliferative phase that may be followed by pulmonary fibrosis. This has been described in patients with COVID-19 pneumonia, but the underlying mechanisms have not been completely defined. We hypothesized that protein mediators of tissue remodeling and monocyte chemotaxis are elevated in the plasma and endotracheal aspirates of critically ill patients with COVID-19 who subsequently develop radiographic fibrosis. We enrolled COVID-19 patients admitted to the ICU who had hypoxemic respiratory failure, were hospitalized and alive for at least 10 days, and had chest imaging done during hospitalization ( n = 119). Plasma was collected within 24h of ICU admission and at 7d. In mechanically ventilated patients, endotracheal aspirates (ETA) were collected at 24h and 48-96h. Protein concentrations were measured by immunoassay. We tested for associations between protein concentrations and radiographic evidence of fibrosis using logistic regression adjusting for age, sex, and APACHE score. We identified 39 patients (33%) with features of fibrosis. Within 24h of ICU admission, plasma proteins related to tissue remodeling (MMP-9, Amphiregulin) and monocyte chemotaxis (CCL-2/MCP-1, CCL-13/MCP-4) were associated with the subsequent development of fibrosis whereas markers of inflammation (IL-6, TNF-α) were not. After 1 week, plasma MMP-9 increased in patients without fibrosis. In ETAs, only CCL-2/MCP-1 was associated with fibrosis at the later timepoint. This cohort study identifies proteins of tissue remodeling and monocyte recruitment that may identify early fibrotic remodeling following COVID-19. Measuring changes in these proteins over time may allow for early detection of fibrosis in patients with COVID-19.
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10
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Krygier A, Szmajda-Krygier D, Świechowski R, Pietrzak J, Wosiak A, Wodziński D, Balcerczak E. Molecular Pathogenesis of Fibrosis, Thrombosis and Surfactant Dysfunction in the Lungs of Severe COVID-19 Patients. Biomolecules 2022; 12:1845. [PMID: 36551272 PMCID: PMC9776352 DOI: 10.3390/biom12121845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
The global scope and scale of the SARS-CoV-2 pandemic led to huge amounts of important data from clinical observations and experimental analyses being collected, in particular, regarding the long-term impact of COVID-19 on lung tissue. Visible changes in lung tissue mainly relate to the destruction of the alveolar architecture, dense cellularity, and pulmonary fibrosis with myofibroblast proliferation and collagen deposition. These changes are the result of infection, mainly with virus variants from the first pandemic waves (Alpha to Delta). In addition, proper regulation of immune responses to pathogenic viral stimuli is critical for the control of and recovery from tissue/organ damage, including in the lungs. We can distinguish three main processes in the lungs during SARS-CoV-2 infection: damage or deficiency of the pulmonary surfactant, coagulation processes, and fibrosis. Understanding the molecular basis of these processes is extremely important in the context of elucidating all pathologies occurring after virus entry. In the present review, data on the abovementioned three biochemical processes that lead to pathological changes are gathered together and discussed. Systematization of the knowledge is necessary to explore the three key pathways in lung tissue after SARS-CoV-2 virus infection as a result of a prolonged and intense inflammatory process in the context of pulmonary fibrosis, hemostatic disorders, and disturbances in the structure and/or metabolism of the surfactant. Despite the fact that the new Omicron variant does not affect the lungs as much as the previous variants, we cannot ignore the fact that other new mutations and emerging variants will not cause serious damage to the lung tissue. In the future, this review will be helpful to stratify the risk of serious complications in patients, to improve COVID-19 treatment outcomes, and to select those who may develop complications before clinical manifestation.
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Affiliation(s)
| | - Dagmara Szmajda-Krygier
- Laboratory of Molecular Diagnostics and Pharmacogenomics, Department of Pharmaceutical Biochemistry and Molecular Diagnostics, Medical University of Lodz, Muszynskiego 1, 90-151 Lodz, Poland
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11
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Karadeniz H, Avanoğlu Güler A, Özger HS, Yıldız PA, Erbaş G, Bozdayı G, Deveci Bulut T, Gülbahar Ö, Yapar D, Küçük H, Öztürk MA, Tufan A. The Prognostic Value of Lung Injury and Fibrosis Markers, KL-6,
TGF-β1, FGF-2 in COVID-19 Patients. Biomark Insights 2022; 17:11772719221135443. [PMCID: PMC9643117 DOI: 10.1177/11772719221135443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022] Open
Abstract
Background: Biomarkers of lung injury and interstitial fibrosis give insight about the
extent of involvement and prognosis in well-known interstitial lung diseases
(ILD). Serum Krebs von den Lungen-6 (KL-6) reflects direct alveolar injury
and, transforming growth factor-beta1 (TGF-β1) and fibroblast growth
factor-2 (FGF-2) are principal mediators of fibrosis in ILD and in almost
all fibrotic diseases. In this sense, we aimed to assess associations of
these biomarkers with traditional inflammatory markers and clinical course
of COVID-19. Methods: Patients with COVID-19 who had confirmed diagnosis with SARS-CoV-2 nucleic
acid RT-PCR were enrolled and followed up prospectively with a standardized
approach one month after diagnosis. Patients were divided into severe and
non-severe groups according to National Institutes of Health criteria.
Outcome was assessed for the requirement of intensive care unit (ICU)
admission, long term respiratory support and death. Blood samples were
collected at enrollment and serum levels of KL-6, TGF-β1, FGF-2 were
determined by ELISA. Association between these markers with other prognostic
markers and prognosis were analyzed. Results: Overall 31 severe and 28 non-severe COVID-19 patients were enrolled and were
compared with healthy control subjects (n = 30). Serum KL-6 levels in
COVID-19 patients were significantly higher (median [IQR]; 11.54 [4.86] vs
8.54 [3.98] ng/mL, P = .001] and FGF-2 levels were lower
(median [IQR]; 76.84 [98.2] vs 101.62 [210.6] pg/mL) compared to healthy
control group. A significant correlation was found between KL-6 values and
CRP, fibrinogen, d-dimer and lymphocyte counts. However, we did not
find an association between these markers and subsequent severity of
COVID-19, mortality and long-term prognosis. Conclusions: Serum KL-6 levels were significantly elevated at the diagnosis of COVID-19
and correlated well with the other traditional prognostic inflammatory
markers. Serum levels of principal fibrosis mediators, TGF-β1, FGF-2, were
not elevated at diagnosis of COVID-19, therefore did not help to anticipate
long term prognosis.
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Affiliation(s)
- Hazan Karadeniz
- Division of Rheumatology, Department of
Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey,Hazan Karadeniz, Department of Internal
Medicine, Division of Rheumatology, Gazi University Faculty of Medicine,
Bahriucok Street, Ankara 06100, Turkey.
| | - Aslıhan Avanoğlu Güler
- Division of Rheumatology, Department of
Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Hasan Selçuk Özger
- Department of Infectious Disease, Gazi
University Faculty of Medicine, Ankara, Turkey
| | - Pınar Aysert Yıldız
- Department of Infectious Disease, Gazi
University Faculty of Medicine, Ankara, Turkey
| | - Gonca Erbaş
- Department of Radiology, Gazi
University Faculty of Medicine, Ankara, Turkey
| | - Gülendam Bozdayı
- Department of Medical Microbiology,
Gazi University Faculty of Medicine, Ankara, Turkey
| | - Tuba Deveci Bulut
- Department of Biochemistry, Gazi
University Faculty of Medicine, Ankara, Turkey
| | - Özlem Gülbahar
- Department of Biochemistry, Gazi
University Faculty of Medicine, Ankara, Turkey
| | - Dilek Yapar
- Department of Public Health and
Biostatistics Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Hamit Küçük
- Division of Rheumatology, Department of
Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Akif Öztürk
- Division of Rheumatology, Department of
Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Abdurrahman Tufan
- Division of Rheumatology, Department of
Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
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12
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Matuszewski M, Szarpak L, Rafique Z, Peacock FW, Pruc M, Szwed P, Chirico F, Navolokina A, Ladny JR, Denegri A. Prediction Value of KREBS Von Den Lungen-6 (KL-6) Biomarker in COVID-19 Patients: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11216600. [PMID: 36362828 PMCID: PMC9658915 DOI: 10.3390/jcm11216600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/02/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022] Open
Abstract
The SARS-CoV-2 (COVID-19) pandemic is a major issue that necessitates the use of cutting-edge disease prediction models. The aim of the study was to assess the existing evidence regarding association between Krebs von den Lungen-6 levels and COVID-19 severity. A literature search was performed on Web of Science, PubMed, Scopus and Cochrane Central Register of Controlled Trials databases from 1 January 2020 up to 2 August 2022. The electronic database search was supplemented by searching Google Scholar. In addition, reference lists of relative articles were also reviewed. KL-6 levels among COVID-19 positive vs. negative patients varied and amounted to 443.37 ± 249.33 vs. 205.73 ± 86.8 U/mL (MD = 275.33; 95%CI: 144.57 to 406.09; p < 0.001). The KL-6 level was 402.82 ± 261.16 U/mL in the severe group and was statistically significantly higher than in the non-severe group (297.38 ± 90.46 U/mL; MD = 192.45; 95%CI: 118.19 to 266.72; p < 0.001). The KL-6 level in the mild group was 272.28 ± 95.42 U/mL, compared to 268.04 ± 55.04 U/mL in the moderate COVID-19 group (MD = −12.58; 95%CI: −21.59 to −3.57; p = 0.006). Our meta-analysis indicates a significant association between increased KL-6 levels and SARS-CoV-2 infection. Moreover, KL-6 levels are significantly higher in patients with a more severe course of COVID-19, indicating that KL-6 may be a useful predictor to identify patients at risk for severe COVID-19.
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Affiliation(s)
- Michal Matuszewski
- Department of Anaesthesiology and Intensive Therapy at the Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland
| | - Lukasz Szarpak
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 00-136 Warsaw, Poland
- Correspondence:
| | - Zubaid Rafique
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Frank W. Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Michal Pruc
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
| | - Piotr Szwed
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Francesco Chirico
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Health Service Department, Italian State Police, Ministry of the Interior, 20121 Milan, Italy
| | - Alla Navolokina
- Department of Public Health and Social Medicine, International European University, 03187 Kyiv, Ukraine
| | - Jerzy R. Ladny
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
- Department of Emergency Medicine, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Andrea Denegri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41121 Modena, Italy
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Usefulness of KL-6 for Predicting Clinical Outcomes in Hospitalized COVID-19 Patients. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101317. [PMID: 36295478 PMCID: PMC9608840 DOI: 10.3390/medicina58101317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 12/02/2022]
Abstract
Background: Krebs von den Lungen 6 (KL-6) is a novel biomarker for interstitial lung disease, and it reflects acute lung injury. We explored the usefulness of KL-6 to predict clinical outcomes in hospitalized coronavirus disease 2019 (COVID-19) patients. Methods: In a total of 48 hospitalized COVID-19 patients, KL-6 levels were measured using the HISCL KL-6 assay (Sysmex, Kobe, Japan) with the HISCL 5000 automated analyzer (Sysmex). Clinical outcomes (intensive care unit [ICU] admission, ventilator use, extracorporeal membrane oxygenation [ECMO] use, and 30-day mortality) were analyzed according to KL-6 percentiles. Age, initial KL-6 level, Charlson comorbidity index (CCI), and critical disease were compared using the receiver operating characteristic (ROC) curve and Kaplan-Meier methods for clinical outcomes. Results: KL-6 quartiles were associated with ICU admission, ventilator use, and ECMO use (all p < 0.05), except 30-day mortality (p = 0.187). On ROC curve analysis, initial KL-6 level predicted ICU admission, ventilator use, and ECMO use significantly better than age, CCI, and critical disease (all p < 0.05); age, initial KL-6 level, CCI, and critical disease predicted 30-day mortality comparably. On Kaplan−Meier survival analysis, hazard ratios (95% confidence interval) were 4.8 (1.2−19.3) for age, 4.7 (1.1−21.6) for initial KL-6 level, 3.9 (0.9−16.2) for CCI, and 2.1 (0.5−10.3) for critical disease. Conclusions: This study demonstrated that KL-6 could be a useful biomarker to predict clinical outcomes in hospitalized COVID-19 patients. KL-6 may contribute to identifying COVID-19 patients requiring critical care, including ICU admission and ventilator and/or ECMO use.
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14
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Transient Pneumonitis as a Possible Adverse Reaction to the BNT162b2 COVID-19 mRNA Vaccine in a Patient with Rheumatoid Arthritis: A Case Report and Review of the Literature. Case Rep Rheumatol 2022; 2022:3124887. [PMID: 36052104 PMCID: PMC9427306 DOI: 10.1155/2022/3124887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/03/2022] [Indexed: 11/18/2022] Open
Abstract
The coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 has led to rapid progress in vaccine development to prevent the spread of the disease. Although COVID-19 vaccines have excellent effectiveness in reducing morbidity and disease severity with minor adverse reactions, some patients develop late hypersensitivity events as autoimmune reactions such as rheumatoid arthritis, lupus nephritis, and vasculitis following COVID-19 vaccination. Herein, we describe a case of pneumonitis following COVID-19 mRNA vaccination in a patient with rheumatoid arthritis, which resolved spontaneously.
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15
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Krebs von den Lungen 6 (KL-6) levels in COVID-19 ICU patients are associated with mortality. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2022. [PMCID: PMC9391655 DOI: 10.1186/s44158-022-00064-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Krebs von den Lungen 6 (KL-6) is a high-molecular-weight mucin-like glycoprotein, which is also known as MUC1. KL-6 is mainly produced by type 2 pneumocytes and bronchial epithelial cells, and, therefore, elevated circulating KL-6 levels may denote disorders of the alveolar epithelial lining. The objective of this study is to verify if KL-6 serum level might support ICU physicians in predicting mortality, risk stratifying and triaging severe COVID-19 patients. Methods A retrospective cohort study, including all the COVID-19 patients who measured KL-6 serum values at least once during their ICU stay, was performed. The study sample, 122 patients, was divided in two groups, according to the median KL-6 value at ICU admission (median log-transformed KL-6 value: 6.73 U/ml; group A: KL-6 lower than the median and group B: KL-6 higher than the median). Results One-hundred twenty-two ICU patients were included in this study. Mortality was higher in group B than in group A (80 versus 46%; p < 0.001); both linear and logistic multivariate analyses showed ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (P/F) significantly and inversely related to KL-6 values. Conclusion At ICU admission, KL-6 serum level was significantly higher in the most hypoxic COVID-19 patients and independently associated with ICU mortality.
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16
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Exploring the Role of Krebs von den Lungen-6 in Severe to Critical COVID-19 Patients. Life (Basel) 2022; 12:life12081141. [PMID: 36013321 PMCID: PMC9409731 DOI: 10.3390/life12081141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 01/02/2023] Open
Abstract
COVID-19 encompasses a broad spectrum of clinical conditions caused by SARS-CoV-2 infection. More severe cases experience acute respiratory and/or multiorgan failure. KL-6 is a glycoprotein expressed mainly from type II alveolar cells with pro-fibrotic properties. Serum KL-6 concentrations have been found in patients with COVID-19. However, the relevance of KL-6 in patients with severe and critical COVID-19 has not been fully elucidated. Methods: Retrospective data from consecutive severe to critical COVID-19 patients were collected at UOC Clinica Pnuemologica “Vanvitelli”, A.O. dei Colli, Naples, Italy. The study included patients with a positive rhinopharyngeal swab for SARS-CoV-2 RNA with severe or critical COVID-19. Results: Among 87 patients, 24 had poor outcomes. The median KL-6 value in survivors was significantly lower when compared with dead or intubated patients (530 U/mL versus 1069 U/mL p < 0.001). KL-6 was correlated with body mass index (BMI) (r: 0.279, p: 0.009), lung ultrasound score (LUS) (r: 0.429, p < 0.001), Chung Score (r: 0.390, p < 0.001). KL-6 was associated with the risk of death or oro-tracheal intubation (IOT) after adjusting for gender, BMI, Charlson Index, Chung Score, and PaO2/FIO2 (OR 1.003 95% CI 1.001−1.004, p < 0.001). Serum KL-6 value of 968 has a sensitivity of 79.2%, specificity of 87.1%, PPV 70.4%, NPV 91.5%, AUC: O.85 for risk of death or IOT. Conclusions: The presented research highlights the relevance of serum KL-6 in severe to critical COVID-19 patients in predicting the risk of death or IOT.
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Anastasi E, Manganaro L, Guiducci E, Ciaglia S, Dolciami M, Spagnoli A, Alessandri F, Angeloni A, Vestri A, Catalano C, Ricci P. Association of serum Krebs von den Lungen-6 and chest CT as potential prognostic factors in severe acute respiratory syndrome SARS-CoV-2: a preliminary experience. Radiol Med 2022; 127:725-732. [PMID: 35704156 PMCID: PMC9199475 DOI: 10.1007/s11547-022-01504-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/18/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To correlate in COVID-19 pneumonia CT-based semi-quantitative score of pulmonary involvement with high serum levels of KL-6, a biomarker of disease severity. METHODS Between March 28 to May 21, 2020, 196 patients with strong suspicion of SARS-CoV-2 were evaluated with RT-PCR for SARS-CoV-2, chest CT scan and blood test, including KL-6 serum protein, in our Emergency Unit. The final population included only patients who underwent blood sampling for KL-6 within 5 days from CT scan (n = 63), including n = 37 COVID-19-positive patients and n = 26 with negative RT-PCR testing for SARS-CoV-2 (control group). A semi-quantitative CT score was calculated based on the extent of lobar involvement (0:0%; 1, < 5%; 2:5-25%; 3:26-50%; 4:51-75%; 5, > 75%; range 0-5; global score 0-25). RESULTS CT score was significantly correlated with serum value of KL-6 (r = 27, p = 0.035). This correlation was also present in COVID-19 positive patients (r = 0.423, p = 0.009) and CT score median value was significantly higher in patients with high KL-6 value (> 400 U/mL; 12.00, IQR 5.00-18.00, p-value 0.027). In control group, no statistically significant correlation was found between CT score and KL-6 value and CT score was higher in patients with high KL-6, although this difference was not statistically significant (5.00, IQR:1.75-8.00 versus 3.50, IQR:2.00-6.50). "Crazy paving" at the right upper (n = 8; 61.5%) and middle lobe (n = 4; 30.8%) and "consolidation" at the middle lobe (n=5; 38.5%) were observed in COVID-19 group with a significant difference between patients with high KL-6 value. CONCLUSION CT score is highly correlated with KL-6 value in COVID-19 patients and might be beneficial to speed-up diagnostic workflow in symptomatic cases.
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Affiliation(s)
- Emanuela Anastasi
- Department of Experimental Medicine, AOU Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, AOU Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Elisa Guiducci
- Department of Radiological, Oncological and Pathological Sciences, AOU Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Simone Ciaglia
- Department of Radiological, Oncological and Pathological Sciences, AOU Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Miriam Dolciami
- Department of Radiological, Oncological and Pathological Sciences, AOU Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Alessandra Spagnoli
- Department of Public Health and Infectious Diseases, AOU Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Francesco Alessandri
- Department of General and Specialist Surgery, AOU Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Antonio Angeloni
- Department of Experimental Medicine, AOU Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Annarita Vestri
- Department of Public Health and Infectious Diseases, AOU Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, AOU Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Paolo Ricci
- Emergency Radiology Unit, Department of Diagnostic Medicine and Radiology, AOU Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy. .,Department of Radiological, Oncological and Pathological Sciences, AOU Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
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18
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Wang L, Foer D, MacPhaul E, Lo YC, Bates DW, Zhou L. PASCLex: A comprehensive post-acute sequelae of COVID-19 (PASC) symptom lexicon derived from electronic health record clinical notes. J Biomed Inform 2022; 125:103951. [PMID: 34785382 PMCID: PMC8590503 DOI: 10.1016/j.jbi.2021.103951] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/06/2021] [Accepted: 11/06/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To develop a comprehensive post-acute sequelae of COVID-19 (PASC) symptom lexicon (PASCLex) from clinical notes to support PASC symptom identification and research. METHODS We identified 26,117 COVID-19 positive patients from the Mass General Brigham's electronic health records (EHR) and extracted 328,879 clinical notes from their post-acute infection period (day 51-110 from first positive COVID-19 test). PASCLex incorporated Unified Medical Language System® (UMLS) Metathesaurus concepts and synonyms based on selected semantic types. The MTERMS natural language processing (NLP) tool was used to automatically extract symptoms from a development dataset. The lexicon was iteratively revised with manual chart review, keyword search, concept consolidation, and evaluation of NLP output. We assessed the comprehensiveness of PASCLex and the NLP performance using a validation dataset and reported the symptom prevalence across the entire corpus. RESULTS PASCLex included 355 symptoms consolidated from 1520 UMLS concepts of 16,466 synonyms. NLP achieved an averaged precision of 0.94 and an estimated recall of 0.84. Symptoms with the highest frequency included pain (43.1%), anxiety (25.8%), depression (24.0%), fatigue (23.4%), joint pain (21.0%), shortness of breath (20.8%), headache (20.0%), nausea and/or vomiting (19.9%), myalgia (19.0%), and gastroesophageal reflux (18.6%). DISCUSSION AND CONCLUSION PASC symptoms are diverse. A comprehensive lexicon of PASC symptoms can be derived using an ontology-driven, EHR-guided and NLP-assisted approach. By using unstructured data, this approach may improve identification and analysis of patient symptoms in the EHR, and inform prospective study design, preventative care strategies, and therapeutic interventions for patient care.
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Affiliation(s)
- Liqin Wang
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, USA,Harvard Medical School, Boston, MA, USA,Corresponding author at: Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, 399 Revolution Dr, Suite 1315, Somerville, MA 02145, USA
| | - Dinah Foer
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, USA,Harvard Medical School, Boston, MA, USA,Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women’s Hospital, USA
| | - Erin MacPhaul
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, USA
| | - Ying-Chih Lo
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, USA,Harvard Medical School, Boston, MA, USA
| | - David W. Bates
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, USA,Harvard Medical School, Boston, MA, USA
| | - Li Zhou
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, USA,Harvard Medical School, Boston, MA, USA
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Mylvaganam RJ, Bailey JI, Sznajder JI, Sala MA. Recovering from a pandemic: pulmonary fibrosis after SARS-CoV-2 infection. Eur Respir Rev 2021; 30:30/162/210194. [PMID: 34911696 PMCID: PMC8674935 DOI: 10.1183/16000617.0194-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/24/2021] [Indexed: 12/15/2022] Open
Abstract
Acute manifestations of SARS-CoV-2 infection continue to impact the lives of many across the world. Post-acute sequelae of coronavirus disease 2019 (COVID-19) may affect 10–30% of survivors of COVID-19, and post-acute sequelae of COVID-19 (PASC)-pulmonary fibrosis is a long-term outcome associated with major morbidity. Data from prior coronavirus outbreaks (severe acute respiratory syndrome and Middle East respiratory syndrome) suggest that pulmonary fibrosis will contribute to long-term respiratory morbidity, suggesting that PASC-pulmonary fibrosis should be thoroughly screened for through pulmonary function testing and cross-sectional imaging. As data accumulates on the unique pathobiologic mechanisms underlying critical COVID-19, a focus on corollaries to the subacute and chronic profibrotic phenotype must be sought as well. Key aspects of acute COVID-19 pathobiology that may account for increased rates of pulmonary fibrosis include monocyte/macrophage–T-cell circuits, profibrotic RNA transcriptomics, protracted elevated levels of inflammatory cytokines, and duration of illness and ventilation. Mechanistic understanding of PASC-pulmonary fibrosis will be central in determining therapeutic options and will ultimately play a role in transplant considerations. Well-designed cohort studies and prospective clinical registries are needed. Clinicians, researchers and healthcare systems must actively address this complication of PASC to minimise disability, maximise quality of life and confront a post-COVID-19 global health crisis. A complication of COVID-19, PASC-pulmonary fibrosis, has the potential to become a global respiratory health crisis. Dedicated surveillance, mechanistic understanding and clinical and research efforts are needed to confront this emerging sequela of COVID-19.https://bit.ly/3GEyB04
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Affiliation(s)
- Ruben J Mylvaganam
- Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joseph I Bailey
- Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jacob I Sznajder
- Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Marc A Sala
- Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Vianello A, Guarnieri G, Braccioni F, Lococo S, Molena B, Cecchetto A, Giraudo C, Bertagna De Marchi L, Caminati M, Senna G. The pathogenesis, epidemiology and biomarkers of susceptibility of pulmonary fibrosis in COVID-19 survivors. Clin Chem Lab Med 2021; 60:307-316. [PMID: 34783228 DOI: 10.1515/cclm-2021-1021] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/08/2021] [Indexed: 12/15/2022]
Abstract
Pulmonary fibrosis (PF), a pathological outcome of chronic and acute interstitial lung diseases associated to compromised wound healing, is a key component of the "post-acute COVID-19 syndrome" that may severely complicate patients' clinical course. Although inconclusive, available data suggest that more than a third of hospitalized COVID-19 patients develop lung fibrotic abnormalities after their discharge from hospital. The pathogenesis of PF in patients recovering from a severe acute case of COVID-19 is complex, and several hypotheses have been formulated to explain its development. An analysis of the data that is presently available suggests that biomarkers of susceptibility could help to identify subjects with increased probability of developing PF and may represent a means to personalize the management of COVID-19's long-term effects. Our review highlights the importance of both patient-related and disease-related contributing risk factors for PF in COVID-19 survivors and makes it definitely clear the possible use of acute phase and follow-up biomarkers for identifying the patients at greatest risk of developing this disease.
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Affiliation(s)
- Andrea Vianello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gabriella Guarnieri
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Fausto Braccioni
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Sara Lococo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Beatrice Molena
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Antonella Cecchetto
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Chiara Giraudo
- Department of Medicine DIMED, University of Padova, Padova, Italy
| | | | - Marco Caminati
- Asthma Center and Allergy Unit, University of Verona, Verona, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, University of Verona, Verona, Italy
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21
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Baldi BG, Tanni SE. Pulmonary fibrosis and follow-up of COVID-19 survivors: an urgent need for clarification. J Bras Pneumol 2021; 47:e20210213. [PMID: 34495179 PMCID: PMC8979668 DOI: 10.36416/1806-3756/e20210213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Bruno Guedes Baldi
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, (SP) Brasil.,. Editor-Chefe, Jornal Brasileiro de Pneumologia, Brasília (DF) Brasil
| | - Suzana Erico Tanni
- . Disciplina de Pneumologia, Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
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