المؤلفون: Urbina, Tomas, Lavillegrand, Jean-Rémi, Garnier, Marc, Mekinian, Arsene, Pacanowski, Jerome, Mario, Nathalie, Dumas, Guillaume, Hariri, Geoffroy, Pilon, Antoine, Darrivère, Lucie, Fartoukh, Muriel, Guidet, Bertrand, Maury, Eric, Leblanc, Judith, Chantran, Yannick, Fain, Olivier, Lacombe, Karine, Voiriot, Guillaume, Ait-Oufella, Hafid

المصدر: Innate Immunity; Jan2022, Vol. 28 Issue 1, p3-10, 8p

مصطلحات موضوعية: CRITICALLY ill, C-reactive protein, INTENSIVE care units, SARS-CoV-2, RETROSPECTIVE studies

مستخلص: Little is known about the immuno-inflammatory response to Tocilizumab and its association with outcome in critically-ill SARS-CoV2 pneumonia. In this multicenter retrospective cohort of SARS-CoV-2 patients admitted to three intensive care units between March and April 2020, we matched on gender and SAPS II 21 Tocilizumab-treated patients to 42 non-treated patients. Need for mechanical ventilation was 76% versus 79%. IL-6, C-reactive protein, and fibrinogen had been collected within the first days of admission (T1), 3 d (T2) and 7 d (T3) later. Tocilizumab-treated patients had persistently higher IL-6 plasma levels and persistently lower C-Reactive protein and fibrinogen levels. Among Tocilizumab-treated patients, baseline levels of inflammatory biomarkers were not different according to outcome. Conversely, C-reactive protein and fibrinogen decrease was delayed in non-survivors. C-Reactive protein decreased at T1 in survivors (45 [30–98] vs 170 [69–204] mg/l, P < 0.001) but only at T2 in non-survivors (37 [13–74] vs 277 [235–288], P = 0.03). Fibrinogen decreased at T2 in survivors (4.11 [3.58–4.69] vs 614 [5.61–7.85] g/l, P = 0.005) but not in non-survivors (4.79 [4.12–7.58] vs 7.24 [6.22–9.24] g/l, P = 0.125). Tocilizumab treatment was thus associated with a persistent both increase in plasma IL-6, and decrease in C-reactive protein and fibrinogen. Among Tocilizumab-treated patients, the decrease in inflammatory biomarkers was delayed in non-survivors. [ABSTRACT FROM AUTHOR]

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المؤلفون: Lavillegrand, Jean-Rémi, Garnier, Marc, Spaeth, Agathe, Mario, Nathalie, Hariri, Geoffroy, Pilon, Antoine, Berti, Enora, Fieux, Fabienne, Thietart, Sara, Urbina, Tomas, Turpin, Matthieu, Darrivere, Lucie, Fartoukh, Muriel, Verdonk, Franck, Dumas, Guillaume, Tedgui, Alain, Guidet, Bertrand, Maury, Eric, Chantran, Yannick, Voiriot, Guillaume

المصدر: Annals of Intensive Care; 6/9/2021, Vol. 11 Issue 1, p1-10, 10p

مصطلحات موضوعية: TREATMENT effectiveness, SARS-CoV-2, CRITICALLY ill, INFLAMMATION, INTERLEUKIN-6

مستخلص: Background: SARS coronavirus 2 (SARS-CoV-2) is responsible for high morbidity and mortality worldwide, mostly due to the exacerbated inflammatory response observed in critically ill patients. However, little is known about the kinetics of the systemic immune response and its association with survival in SARS-CoV-2+ patients admitted in ICU. We aimed to compare the immuno-inflammatory features according to organ failure severity and in-ICU mortality. Methods: Six-week multicentre study (N = 3) including SARS-CoV-2+ patients admitted in ICU. Analysis of plasma biomarkers at days 0 and 3–4 according to organ failure worsening (increase in SOFA score) and 60-day mortality. Results: 101 patients were included. Patients had severe respiratory diseases with PaO2/FiO2 of 155 [111–251] mmHg), SAPS II of 37 [31–45] and SOFA score of 4 [3–7]. Eighty-three patients (83%) required endotracheal intubation/mechanical ventilation and among them, 64% were treated with prone position. IL-1β was barely detectable. Baseline IL-6 levels positively correlated with organ failure severity. Baseline IL-6 and CRP levels were significantly higher in patients in the worsening group than in the non-worsening group (278 [70–622] vs. 71 [29–153] pg/mL, P < 0.01; and 178 [100–295] vs. 100 [37–213] mg/L, P < 0.05, respectively). Baseline IL-6 and CRP levels were significantly higher in non-survivors compared to survivors but fibrinogen levels and lymphocyte counts were not different between groups. After adjustment on SOFA score and time from symptom onset to first dosage, IL-6 and CRP remained significantly associated with mortality. IL-6 changes between Day 0 and Day 3–4 were not different according to the outcome. A contrario, kinetics of CRP and lymphocyte count were different between survivors and non-survivors. Conclusions: In SARS-CoV-2+ patients admitted in ICU, a systemic pro-inflammatory signature was associated with clinical worsening and 60-day mortality. [ABSTRACT FROM AUTHOR]

: Copyright of Annals of Intensive Care is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Lavillegrand, Jean-Rémi, Garnier, Marc, Spaeth, Agathe, Mario, Nathalie, Hariri, Geoffroy, Pilon, Antoine, Berti, Enora, Fieux, Fabienne, Thietart, Sara, Urbina, Tomas, Turpin, Matthieu, Darrivière, Lucie, Fartoukh, Muriel, Verdonk, Franck, Dumas, Guillaume, Tedgui, Alain, Guidet, Bertrand, Maury, Eric, Chantran, Yannick, Voiriot, Guillaume

المصدر: Annals of Intensive Care; 1/13/2021, Vol. 11 Issue 1, p1-10, 10p

مستخلص: Background: SARS coronavirus 2 (SARS-CoV-2) is responsible for high morbidity and mortality worldwide, mostly due to the exacerbated inflammatory response observed in critically ill patients. However, little is known about the kinetics of the systemic immune response and its association with survival in SARS-CoV-2+ patients admitted in ICU. We aimed to compare the immuno-inflammatory features according to organ failure severity and in-ICU mortality. Methods: Six-week multicentre study (N = 3) including SARS-CoV-2+ patients admitted in ICU. Analysis of plasma biomarkers at days 0 and 3–4 according to organ failure worsening (increase in SOFA score) and 60-day mortality. Results: 101 patients were included. Patients had severe respiratory diseases with PaO2/FiO2 of 155 [111–251] mmHg), SAPS II of 37 [31–45] and SOFA score of 4 [3–7]. Eighty-three patients (83%) required endotracheal intubation/mechanical ventilation and among them, 64% were treated with prone position. IL-1β was barely detectable. Baseline IL-6 levels positively correlated with organ failure severity. Baseline IL-6 and CRP levels were significantly higher in patients in the worsening group than in the non-worsening group (278 [70–622] vs. 71 [29–153] pg/mL, P < 0.01; and 178 [100–295] vs. 100 [37–213] mg/L, P < 0.05, respectively). Baseline IL-6 and CRP levels were significantly higher in non-survivors compared to survivors but fibrinogen levels and lymphocyte counts were not different between groups. After adjustment on SOFA score and time from symptom onset to first dosage, IL-6 and CRP remained significantly associated with mortality. IL-6 changes between Day 0 and Day 3–4 were not different according to the outcome. A contrario, kinetics of CRP and lymphocyte count were different between survivors and non-survivors. Conclusions: In SARS-CoV-2+ patients admitted in ICU, a systemic pro-inflammatory signature was associated with clinical worsening and 60-day mortality. [ABSTRACT FROM AUTHOR]

: Copyright of Annals of Intensive Care is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)