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Dündar NB, Sarphie D, Yüce K, Gaygısız Ü, Kaskatı OT, Türkoğlu M, Bıkmaz GA, Karabıyık L, Çağlar K, Bozdayı G, Mian R, Moss P, İlhan MN. Assessing neutrophil-derived ROS production at the bedside: a potential prognostic tool in severe COVID-19 cases. Intensive Care Med Exp 2023; 11:69. [PMID: 37801184 PMCID: PMC10558411 DOI: 10.1186/s40635-023-00554-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023] Open
Abstract
PURPOSE A prompt and effective immune response is required for clearance of pathogens but exaggerated states of inflammation can cause extensive collateral damage to the host. We have previously used a rapid near-patient assay that measures the functional capacity of neutrophils to produce reactive oxygen species (ROS) to show that values are elevated in patients with severe COVID-19 or sepsis. Here, we assess the utility of longitudinal ROS measurements to monitor and predict mortality outcome for patients with COVID-19 infection being treated in an ICU setting. METHODS We used the Leukocyte ImmunoTest™ (LIT™) to quantify neutrophil ROS release using a small volume (10 µL) of capillary blood in a portable, rapid (10-min) format. RESULTS ROS values (LIT score) and ROS levels assessed in relation to neutrophil count (LIT/N) were both markedly elevated in the patient group. Furthermore, these correlated strongly with peripheral neutrophil count and CRP value. Serial measurement of neutrophil or CRP values were not able to reliably predict mortality within the study. In contrast, LIT and LIT/N values started to decline at 7 and 5 days, respectively, in patients who survived ICU admission and this increment increased further thereafter. CONCLUSIONS This study raises the possibility of LIT and LIT/N to be used as a predictive clinical tool for patients with severe COVID-19 and argues for its assessment to inform on prognosis, and potentially guide treatment pathways, in other disorders associated with neutrophil activation. TAKE-HOME MESSAGE A longitudinal study of 44 severe COVID-19 patients in the ICU of a leading teaching hospital has demonstrated the prognostic potential of a rapid bedside assay of neutrophil-derived reactive oxygen species (ROS). Assessment of changes in ROS production, as measured using the Leukocyte ImmunoTest™, shows that ROS production generally declined back to normal levels for patients who survived, but remained elevated for those patients who did not survive.
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Affiliation(s)
- Nazlıhan Boyacı Dündar
- Department of Internal Medicine, Division of Intensive Care Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | | | - Kenan Yüce
- Department of Clinical Microbiology, Division of Virology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ümmügülsüm Gaygısız
- Department of Anesthesiology and Reanimation, Division of Intensive Care Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - O Tolga Kaskatı
- Department of Biostatistics, Faculty of Medicine, Lokman Hekim University, Ankara, Turkey
| | - Melda Türkoğlu
- Department of Internal Medicine, Division of Intensive Care Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Gülbin Aygencel Bıkmaz
- Department of Internal Medicine, Division of Intensive Care Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Lale Karabıyık
- Department of Anesthesiology and Reanimation, Division of Intensive Care Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Kayhan Çağlar
- Department of Clinical Microbiology, Division of Virology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Gülendam Bozdayı
- Department of Clinical Microbiology, Division of Virology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | | | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mustafa Necmi İlhan
- Department of Public Health, Faculty of Medicine, Gazi University, Ankara, Turkey
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Veenith T, Martin H, Le Breuilly M, Whitehouse T, Gao-Smith F, Duggal N, Lord JM, Mian R, Sarphie D, Moss P. High generation of reactive oxygen species from neutrophils in patients with severe COVID-19. Sci Rep 2022; 12:10484. [PMID: 35729319 PMCID: PMC9212205 DOI: 10.1038/s41598-022-13825-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 05/27/2022] [Indexed: 12/25/2022] Open
Abstract
Neutrophilia and an elevated neutrophil:lymphocyte ratio are both characteristic features of severe COVID-19 infection. However, functional neutrophil responses have been poorly investigated in this setting. We utilised a novel PMA-based stimulation assay to determine neutrophil-derived reactive oxygen species (ROS) generation in patients with severe COVID-19 infection, non-COVID related sepsis and healthy study participants. ROS production was markedly elevated in COVID-19 patients with median values ninefold higher than in healthy controls and was particularly high in patients on mechanical ventilation. ROS generation correlated strongly with neutrophil count and elevated levels were also seen in patients with non-COVID related sepsis. Relative values, adjusted for neutrophil count, were high in both groups but extreme low or high values were seen in two patients who died shortly after testing, potentially indicating a predictive value for neutrophil function. Our results show that the high levels of neutrophils observed in patients with COVID-19 and sepsis exhibit functional capacity for ROS generation. This may contribute to the clinical features of acute disease and represents a potential novel target for therapeutic intervention.
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Affiliation(s)
- Tonny Veenith
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Birmingham Acute Care Research, University of Birmingham, Birmingham, UK
| | - Helena Martin
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Birmingham Acute Care Research, University of Birmingham, Birmingham, UK
| | - Martin Le Breuilly
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Birmingham Acute Care Research, University of Birmingham, Birmingham, UK
| | - Tony Whitehouse
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Birmingham Acute Care Research, University of Birmingham, Birmingham, UK
| | - Fang Gao-Smith
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Birmingham Acute Care Research, University of Birmingham, Birmingham, UK
| | - Niharika Duggal
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Janet M Lord
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | | | | | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
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