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De Rose DU, Pace PG, Ceccherini-Silberstein F, Dotta A, Andreoni M, Sarmati L, Iannetta M. T Lymphocyte Subset Counts and Interferon-Gamma Production in Adults and Children with COVID-19: A Narrative Review. J Pers Med 2023; 13:jpm13050755. [PMID: 37240926 DOI: 10.3390/jpm13050755] [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: 03/22/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Adults and children exhibit a broad range of clinical outcomes from SARS-CoV-2 infection, with minimal to mild symptoms, especially in the pediatric age. However, some children present with a severe hyperinflammatory post-infectious complication named multisystem inflammatory syndrome in children (MIS-C), mainly affecting previously healthy subjects. Understanding these differences is still an ongoing challenge, that can lead to new therapeutic strategies and avoid unfavorable outcomes. In this review, we discuss the different roles of T lymphocyte subsets and interferon-γ (IFN-γ) in the immune responses of adults and children. Lymphopenia can influence these responses and represent a good predictor for the outcome, as reported by most authors. The increased IFN-γ response exhibited by children could be the starting point for the activation of a broad response that leads to MIS-C, with a significantly higher risk than in adults, although a single IFN signature has not been identified. Multicenter studies with large cohorts in both age groups are still needed to study SARS-CoV-2 pathogenesis with new tools and to understand how is possible to better modulate immune responses.
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Affiliation(s)
- Domenico Umberto De Rose
- Neonatal Intensive Care Unit, "Bambino Gesù" Children's Hospital IRCCS, 00165 Rome, Italy
- PhD Course in Microbiology, Immunology, Infectious Diseases, and Transplants (MIMIT), Faculty of Medicine and Surgery, "Tor Vergata" University of Rome, 00133 Rome, Italy
| | - Pier Giorgio Pace
- Infectious Disease Unit, Department of System Medicine, "Tor Vergata" University and Hospital, 00133 Rome, Italy
| | | | - Andrea Dotta
- Neonatal Intensive Care Unit, "Bambino Gesù" Children's Hospital IRCCS, 00165 Rome, Italy
| | - Massimo Andreoni
- Infectious Disease Unit, Department of System Medicine, "Tor Vergata" University and Hospital, 00133 Rome, Italy
| | - Loredana Sarmati
- Infectious Disease Unit, Department of System Medicine, "Tor Vergata" University and Hospital, 00133 Rome, Italy
| | - Marco Iannetta
- Infectious Disease Unit, Department of System Medicine, "Tor Vergata" University and Hospital, 00133 Rome, Italy
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Iannetta M, Buccisano F, Fraboni D, Malagnino V, Campogiani L, Teti E, Spalliera I, Rossi B, Di Lorenzo A, Palmieri R, Crea A, Zordan M, Vitale P, Voso MT, Andreoni M, Sarmati L. Baseline T-lymphocyte subset absolute counts can predict both outcome and severity in SARS-CoV-2 infected patients: a single center study. Sci Rep 2021; 11:12762. [PMID: 34140530 PMCID: PMC8211786 DOI: 10.1038/s41598-021-90983-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 05/18/2021] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to evaluate the role of baseline lymphocyte subset counts in predicting the outcome and severity of COVID-19 patients. Hospitalized patients confirmed to be infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) were included and classified according to in-hospital mortality (survivors/nonsurvivors) and the maximal oxygen support/ventilation supply required (nonsevere/severe). Demographics, clinical and laboratory data, and peripheral blood lymphocyte subsets were retrospectively analyzed. Overall, 160 patients were retrospectively included in the study. T-lymphocyte subset (total CD3+, CD3+ CD4+, CD3+ CD8+, CD3+ CD4+ CD8+ double positive [DP] and CD3+ CD4− CD8− double negative [DN]) absolute counts were decreased in nonsurvivors and in patients with severe disease compared to survivors and nonsevere patients (p < 0.001). Multivariable logistic regression analysis showed that absolute counts of CD3+ T-lymphocytes < 524 cells/µl, CD3+ CD4+ < 369 cells/µl, and the number of T-lymphocyte subsets below the cutoff (T-lymphocyte subset index [TLSI]) were independent predictors of in-hospital mortality. Baseline T-lymphocyte subset counts and TLSI were also predictive of disease severity (CD3+ < 733 cells/µl; CD3+ CD4+ < 426 cells/µl; CD3+ CD8+ < 262 cells/µl; CD3+ DP < 4.5 cells/µl; CD3+ DN < 18.5 cells/µl). The evaluation of peripheral T-lymphocyte absolute counts in the early stages of COVID-19 might represent a useful tool for identifying patients at increased risk of unfavorable outcomes.
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Affiliation(s)
- Marco Iannetta
- Department of System Medicine, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy. .,Infectious Disease Clinic, Policlinico Tor Vergata, Rome, Italy.
| | - Francesco Buccisano
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Daniela Fraboni
- Department of Oncohematology, Policlinico Tor Vergata, Rome, Italy
| | - Vincenzo Malagnino
- Department of System Medicine, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy.,Infectious Disease Clinic, Policlinico Tor Vergata, Rome, Italy
| | - Laura Campogiani
- Department of System Medicine, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy.,Infectious Disease Clinic, Policlinico Tor Vergata, Rome, Italy
| | - Elisabetta Teti
- Department of System Medicine, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy.,Infectious Disease Clinic, Policlinico Tor Vergata, Rome, Italy
| | - Ilaria Spalliera
- Department of System Medicine, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy.,Infectious Disease Clinic, Policlinico Tor Vergata, Rome, Italy
| | - Benedetta Rossi
- Department of System Medicine, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy.,Infectious Disease Clinic, Policlinico Tor Vergata, Rome, Italy
| | - Andrea Di Lorenzo
- Department of System Medicine, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy.,Infectious Disease Clinic, Policlinico Tor Vergata, Rome, Italy
| | - Raffaele Palmieri
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Angela Crea
- Department of System Medicine, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy.,Infectious Disease Clinic, Policlinico Tor Vergata, Rome, Italy
| | - Marta Zordan
- Department of System Medicine, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy.,Infectious Disease Clinic, Policlinico Tor Vergata, Rome, Italy
| | - Pietro Vitale
- Department of System Medicine, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy.,Infectious Disease Clinic, Policlinico Tor Vergata, Rome, Italy
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy.,Department of Oncohematology, Policlinico Tor Vergata, Rome, Italy
| | - Massimo Andreoni
- Department of System Medicine, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy.,Infectious Disease Clinic, Policlinico Tor Vergata, Rome, Italy
| | - Loredana Sarmati
- Department of System Medicine, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy.,Infectious Disease Clinic, Policlinico Tor Vergata, Rome, Italy
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Lu W, Yang L, Li X, Sun M, Zhang A, Qi S, Chen Z, Zhang L, Li J, Xiong H. Early immune responses and prognostic factors in children with COVID-19: a single-center retrospective analysis. BMC Pediatr 2021; 21:181. [PMID: 33865340 PMCID: PMC8052550 DOI: 10.1186/s12887-021-02561-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/15/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Early diagnostic indicators and the identification of possible progression to severe or critical COVID-19 in children are unknown. To investigate the immune characteristics of early SARS-CoV-2 infection in children and possible key prognostic factors for early identification of critical COVID-19, a retrospective study including 121 children with COVID-19 was conducted. Peripheral blood lymphocyte subset counts, T cell-derived cytokine concentrations, inflammatory factor concentrations, and routine blood counts were analyzed statistically at the initial presentation. RESULTS The T lymphocyte subset and natural killer cell counts decreased with increasing disease severity. Group III (critical cases) had a higher Th/Tc ratio than groups I and II (common and severe cases); group I had a higher B cell count than groups II and III. IL-6, IL-10, IFN-γ, SAA, and procalcitonin levels increased with increasing disease severity. Hemoglobin concentration, and RBC and eosinophil counts decreased with increasing disease severity. Groups II and III had significantly lower lymphocyte counts than group I. T, Th, Tc, IL-6, IL-10, RBC, and hemoglobin had relatively high contribution and area under the curve values. CONCLUSIONS Decreased T, Th, Tc, RBC, hemoglobin and increased IL-6 and IL-10 in early SARS-CoV-2 infection in children are valuable indices for early diagnosis of severe disease. The significantly reduced Th and Tc cells and significantly increased IL-6, IL-10, ferritin, procalcitonin, and SAA at this stage in children with critical COVID-19 may be closely associated with the systemic cytokine storm caused by immune dysregulation.
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Affiliation(s)
- Wenjie Lu
- Department of Hematology, Wuhan Children's Hospital (Wuhan Medical Care Center for Women and Children), Tongji College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Li Yang
- Department of Hematology, Wuhan Children's Hospital (Wuhan Medical Care Center for Women and Children), Tongji College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiong Li
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, MI, USA
- Center of Excellence for Cancer Immunology and Immunotherapy, University of Michigan Rogel Cancer Center, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Ming Sun
- Department of Hematology, Wuhan Children's Hospital (Wuhan Medical Care Center for Women and Children), Tongji College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Aiping Zhang
- Department of Hematology, Wuhan Children's Hospital (Wuhan Medical Care Center for Women and Children), Tongji College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shanshan Qi
- Department of Hematology, Wuhan Children's Hospital (Wuhan Medical Care Center for Women and Children), Tongji College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhi Chen
- Department of Hematology, Wuhan Children's Hospital (Wuhan Medical Care Center for Women and Children), Tongji College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lannan Zhang
- Department of Hematology, Wuhan Children's Hospital (Wuhan Medical Care Center for Women and Children), Tongji College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jianxin Li
- Department of Hematology, Wuhan Children's Hospital (Wuhan Medical Care Center for Women and Children), Tongji College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hao Xiong
- Department of Hematology, Wuhan Children's Hospital (Wuhan Medical Care Center for Women and Children), Tongji College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Host-Pathogen Responses to Pandemic Influenza H1N1pdm09 in a Human Respiratory Airway Model. Viruses 2020; 12:v12060679. [PMID: 32599823 PMCID: PMC7354428 DOI: 10.3390/v12060679] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023] Open
Abstract
The respiratory Influenza A Viruses (IAVs) and emerging zoonotic viruses such as Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) pose a significant threat to human health. To accelerate our understanding of the host–pathogen response to respiratory viruses, the use of more complex in vitro systems such as normal human bronchial epithelial (NHBE) cell culture models has gained prominence as an alternative to animal models. NHBE cells were differentiated under air-liquid interface (ALI) conditions to form an in vitro pseudostratified epithelium. The responses of well-differentiated (wd) NHBE cells were examined following infection with the 2009 pandemic Influenza A/H1N1pdm09 strain or following challenge with the dsRNA mimic, poly(I:C). At 30 h postinfection with H1N1pdm09, the integrity of the airway epithelium was severely impaired and apical junction complex damage was exhibited by the disassembly of zona occludens-1 (ZO-1) from the cell cytoskeleton. wdNHBE cells produced an innate immune response to IAV-infection with increased transcription of pro- and anti-inflammatory cytokines and chemokines and the antiviral viperin but reduced expression of the mucin-encoding MUC5B, which may impair mucociliary clearance. Poly(I:C) produced similar responses to IAV, with the exception of MUC5B expression which was more than 3-fold higher than for control cells. This study demonstrates that wdNHBE cells are an appropriate ex-vivo model system to investigate the pathogenesis of respiratory viruses.
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Elsayed SM, Hassanein OM, Hassan NHA. Influenza A (H1N1) virus infection and TNF-308, IL6, and IL8 polymorphisms in Egyptian population: a case-control study. JOURNAL OF BASIC & APPLIED ZOOLOGY 2019; 80:61. [PMID: 32219005 PMCID: PMC7091895 DOI: 10.1186/s41936-019-0131-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/02/2019] [Indexed: 05/31/2023]
Abstract
BACKGROUND The importance of influenza is increasing mainly because of the appearance of novel pandemic strains such as swine and avian. Each year, influenza has spread around the world causing about 250,000-500,000 deaths and more than 5 million cases of severe illness.The objective is as follows: evaluating the outcomes of patients with influenza A (H1N1) virus in relation to certain TNF-308, IL6, and IL8 polymorphisms and identifying the associated factors with the severe outcome. SUBJECT AND METHODS This is a case-control study. The cases were patients confirmed by real-time polymerase chain reaction (RT-PCR) to be influenza A (H1N1) virus infected. The controls were healthy individuals. Medical history and outcome of the disease was registered. In all study participants, polymorphisms of TNF rs1800629, IL6 rs18138879, and IL8 rs4073; odds ratio (OR); and the 95% confidence interval (95% CI) were calculated. RESULTS Infection with influenza A (H1N1) virus was associated more with the following genotypes: TNF-308 AA (OR = 4.041; 95% CI = 1.215-13.4) and IL8 AA (OR = 3.273; 95% CI = 1.372-7.805). According to our study results, HCV (OR = 3.2, 95% CI 1.2-8.5), renal disease (OR = 3.4, 95% CI 0.9-13.6), cancer (OR = 3.1, 95% CI 0.3-31.1), TB (OR = 8.4, 95% CI 1.8-39.7), ICU (OR = 2.9, 95%1.2-7.1), and mortality (OR = 7.9, 95% CI 0.9-67.4) are considered as risk factors for influenza A (H1N1)-infected patients. CONCLUSIONS Our findings concluded that TNF-308 (AA) and IL8 (AA) polymorphisms may increase the susceptibility to be infected with H1N1influenza virus.
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Affiliation(s)
- Shaimaa Moustafa Elsayed
- Molecular Biology & Epigenetics, Faculty of Medicine, Medical Ain Shams Research institute (MASRI), Ain Shams University Hospitals, Cairo, Egypt
| | - Omayma Mohamed Hassanein
- Molecular Biology Department, Faculty of Medicine, Ain Shams Research Institute (MASRI), Ain Shams University Hospitals, Cairo, Egypt
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Abstract
Influenza virus infection often causes severe disease and acute respiratory distress syndrome. It is a common belief that overwhelming immune response contributes to the severe illness. Physicians and researchers have put forth immune modulation as salvage therapy for better recovery. However, empiric corticosteroid failed in both humans and animal models. Reported success with Rapamycin in humans prompted a comprehensive animal study and mechanistic dissection. Here we report the effect of Rapamycin alone or in combination with Oseltamivir for severe influenza in BALB/c mice. We found that Rapamycin had no antiviral effect against H1N1, H3N2 and novel-H1N1 influenza viruses in vitro. Rapamycin alone aggravated the severe disease of PR8 H1N1 influenza virus infection in mice. Timely Oseltamivir anti-viral therapy abolished the disease. Delayed Oseltamivir treatment could not prevent severe illness and Rapamycin adjuvant was associated with exacerbated disease. Rapamycin adjuvant suppressed influenza hemagglutinin antigen-specific T cell immunity and impaired virus clearance from the lungs. It also resulted in intensified lung pathology with increased intra-alveolar edema and hyaline deposition. Rapamycin may work as the salvage therapy for severe influenza but it is very difficult to define the appropriate window for such treatment to take effect.
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IL-10 inhibits neuraminidase-activated TGF-β and facilitates Th1 phenotype during early phase of infection. Nat Commun 2015; 6:6374. [DOI: 10.1038/ncomms7374] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/23/2015] [Indexed: 12/12/2022] Open
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Chen WW, Nie WM, Xu W, Xie YX, Tu B, Zhao P, Qin EQ, Zhang YH, Zhang X, Li WG, Zhou ZP, Lv JY, Zhao M. Cross-sectional study of the relationship of peripheral blood cell profiles with severity of infection by adenovirus type 55. BMC Infect Dis 2014; 14:147. [PMID: 24646014 PMCID: PMC4000060 DOI: 10.1186/1471-2334-14-147] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 03/14/2014] [Indexed: 11/10/2022] Open
Abstract
Background The immunologic profiles of patients with human adenovirus serotype 55 (HAdV-55) infections were characterized in subjects diagnosed with silent infections (n = 30), minor infections (n = 27), severe infections (n = 34), and healthy controls (n = 30) during a recent outbreak among Chinese military trainees. Methods Blood was sampled at the disease peak and four weeks later, and samples were analyzed to measure changes in leukocyte and platelet profiles in patients with different severities of disease. Differential lymphocyte subsets and cytokine profiles were measured by flow cytometry and Luminex xMAP®, and serum antibodies were analyzed by ELISA and immunofluorescence staining. Results Patients with severe HAdV infections had higher proportions of neutrophils and reduced levels of lymphocytes (p < 0.005 for both). Patients with minor and severe infections had significantly lower platelet counts (p < 0.005 for both) than those with silent infections. The silent and minor infection groups had higher levels of dendritic cells than the severe infection group. Relative to patients with silent infections, patients with severe infections had significantly higher levels of IL-17+CD4+ cells, decreased levels of IL-17+CD8+ cells, and higher levels of IFN-γ, IL-4, IL-10, and IFN-α2 (p < 0.001 for all comparisons). Conclusions Patients with different severities of disease due to HAdV-55 infection had significantly different immune responses. These data provide an initial step toward the identification of patients at risk for more severe disease and the development of treatments against HAdV-55 infection.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Ji-Yun Lv
- School of Management, University of Chinese Academy of Sciences, No, 80 East Road Zhongguancun, 100190 Beijing, China.
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PD-L1 expression induced by the 2009 pandemic influenza A(H1N1) virus impairs the human T cell response. Clin Dev Immunol 2013; 2013:989673. [PMID: 24187568 PMCID: PMC3803123 DOI: 10.1155/2013/989673] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 08/22/2013] [Indexed: 12/31/2022]
Abstract
PD-L1 expression plays a critical role in the impairment of T cell responses during chronic infections; however, the expression of PD-L1 on T cells during acute viral infections, particularly during the pandemic influenza virus (A(H1N1)pdm09), and its effects on the T cell response have not been widely explored. We found that A(H1N1)pdm09 virus induced PD-L1 expression on human dendritic cells (DCs) and T cells, as well as PD-1 expression on T cells. PD-L1 expression impaired the T cell response against A(H1N1)pdm09 by promoting CD8+ T cell death and reducing cytokine production. Furthermore, we found increased PD-L1 expression on DCs and T cells from influenza-infected patients from the first and second 2009 pandemic waves in Mexico City. PD-L1 expression on CD8+ T cells correlated inversely with T cell proportions in patients infected with A(H1N1)pdm09. Therefore, PD-L1 expression on DCs and T cells could be associated with an impaired T cell response during acute infection with A(H1N1)pdm09 virus.
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Davey RT, Lynfield R, Dwyer DE, Losso MH, Cozzi-Lepri A, Wentworth D, Lane HC, Dewar R, Rupert A, Metcalf JA, Pett SL, Uyeki TM, Bruguera JM, Angus B, Cummins N, Lundgren J, Neaton JD. The association between serum biomarkers and disease outcome in influenza A(H1N1)pdm09 virus infection: results of two international observational cohort studies. PLoS One 2013; 8:e57121. [PMID: 23468921 PMCID: PMC3584122 DOI: 10.1371/journal.pone.0057121] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 01/15/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Prospective studies establishing the temporal relationship between the degree of inflammation and human influenza disease progression are scarce. To assess predictors of disease progression among patients with influenza A(H1N1)pdm09 infection, 25 inflammatory biomarkers measured at enrollment were analyzed in two international observational cohort studies. METHODS Among patients with RT-PCR-confirmed influenza A(H1N1)pdm09 virus infection, odds ratios (ORs) estimated by logistic regression were used to summarize the associations of biomarkers measured at enrollment with worsened disease outcome or death after 14 days of follow-up for those seeking outpatient care (FLU 002) or after 60 days for those hospitalized with influenza complications (FLU 003). Biomarkers that were significantly associated with progression in both studies (p<0.05) or only in one (p<0.002 after Bonferroni correction) were identified. RESULTS In FLU 002 28/528 (5.3%) outpatients had influenza A(H1N1)pdm09 virus infection that progressed to a study endpoint of complications, hospitalization or death, whereas in FLU 003 28/170 (16.5%) inpatients enrolled from the general ward and 21/39 (53.8%) inpatients enrolled directly from the ICU experienced disease progression. Higher levels of 12 of the 25 markers were significantly associated with subsequent disease progression. Of these, 7 markers (IL-6, CD163, IL-10, LBP, IL-2, MCP-1, and IP-10), all with ORs for the 3(rd) versus 1(st) tertile of 2.5 or greater, were significant (p<0.05) in both outpatients and inpatients. In contrast, five markers (sICAM-1, IL-8, TNF-α, D-dimer, and sVCAM-1), all with ORs for the 3(rd) versus 1(st) tertile greater than 3.2, were significantly (p≤.002) associated with disease progression among hospitalized patients only. CONCLUSIONS In patients presenting with varying severities of influenza A(H1N1)pdm09 virus infection, a baseline elevation in several biomarkers associated with inflammation, coagulation, or immune function strongly predicted a higher risk of disease progression. It is conceivable that interventions designed to abrogate these baseline elevations might affect disease outcome.
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Affiliation(s)
- Richard T Davey
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
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