Prognostic significance of cytokine dysregulation in critically ill COVID-19 patients.
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Lemos Fabian Fellipe Bueno, Lopes Luana Weber, Brito Gabriel Carvalho, Viana Airton Idalecio Sousa, de Castro Caroline Tianeze, Luz Marcel Silva, Gonçalves André Pereira, Dórea Rafael Santos Dantas Miranda, da Silva Filipe Antônio França, de Brito Breno Bittencourt, Santos Maria Luísa Cordeiro, Júnior Geovani Moreno Santos, de Lorenzo Barcia Maria Teresa Araújo, de Amorim Marques Renata, Botelho André Bezerra, Dantas Anna Carolina Saúde, Pinheiro Fillipe Dantas, Teixeira Adriano Fernandes, Souza Cláudio Lima, Oliveira Márcio Vasconcelos, de Magalhães Queiroz Dulciene Maria, de Melo Fabrício Freire
Аннотация
METHODS: We conducted a single-center, prospective study involving 56 unvaccinated COVID-19 patients admitted to the ICU. Plasma cytokine levels at admission were quantified using enzyme-linked immunosorbent assay (ELISA). Continuous variables were presented as median (IQR), and categorical variables as frequencies and percentages. Non-parametric tests assessed group differences. Logistic regression and receiver operating characteristic (ROC) curve analyses identified predictors of mortality, with bootstrapping (1000 re-samplings; 95 % BCa CI) applied for model validation.
RESULTS: Deceased patients exhibited significantly higher levels of interleukin (IL)-1β, IL-2, IL-6, transforming growth factor (TGF)-β, and interferon (IFN)-γ compared to survivors. Conversely, IL-10 and IL-27 were associated with favorable outcomes. Logistic regression modeling identified elevated IL-2 and IFN-γ levels as significant predictors of mortality. Notably, individual ROC curve analyses demonstrated that IL-1β and TGF-β had excellent discriminatory ability for mortality, while IFN-γ, IL-2, and IL-27 showed very good to excellent discriminatory capacity.
CONCLUSION: Our results indicate that distinct cytokine profiles differentiate survivors from non-survivors in critically ill, unvaccinated COVID-19 patients. These findings highlight the importance of cytokine dysregulation in severe COVID-19 cases and suggest potential targets for prognostic approaches. Further research is warranted to validate these results and translate them into effective clinical management strategies.