Differences in leucocytes and inflammation-based indices among critically ill patients owing to SARS-CoV-2 variants during several successive waves of COVID-19 pandemic
•Dysregulation of immune response depended to the SARS-CoV-2 strain.•Inflammatory indices fluctuated between COVID-19 waves.•Sustained high inflammatory indices levels associated with COVID-19 mortality.•Prognostic immune markers closely associated with SARS-CoV-2 strain.•Systemic inflammatory state...
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| Published in: | International immunopharmacology Vol. 124; p. 110836 |
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| Main Authors: | , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Elsevier B.V
01-11-2023
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | •Dysregulation of immune response depended to the SARS-CoV-2 strain.•Inflammatory indices fluctuated between COVID-19 waves.•Sustained high inflammatory indices levels associated with COVID-19 mortality.•Prognostic immune markers closely associated with SARS-CoV-2 strain.•Systemic inflammatory state impacted survival rates and respiratory failure.
Inflammatory indices are useful informative markers in assessing the severity of the COVID-19 disease course; however, their involvements during series waves of SARS-CoV-2 virus outbreaks in critical patients with COVID-19 remain unclear. Hence, we aimed to ascertain the changing dynamics of the combined inflammatory indices (NLR, dNLR, CLR, LMR, PLR, SII, and SIRI) and their associations with clinical outcomes in severe COVID-19 patients during serial waves of SARS-CoV-2.
We retrospectively enrolled 163 severe COVID-19 patients admitted to the ICU during six SARS-CoV-2 waves.
We found that most of patients admitted to the ICU were from the fourth wave. Patients in the fourth wave were considerably younger and had the highest percentage of ARDS than other waves. The highest CRP was found in the first wave, while the lowest in patients admitted in the sixth wave. Although most of the COVID-19 waves were marked with leukocytosis, neutrophilia, and lymphocytopenia, the lowest of both NLR and dNLR were found in the fourth wave “Delta wave” and the lowest of both CLR and SII were observed in “Omicron wave”. Interestingly, during most of the COVID-19 waves, the derived combined inflammatory ratio NLR, dNLR, CLR, SII and SIRI were sustained at high levels in fatal cases at the last day of hospitalization, while these indices declined in the alive group at the end of ICU hospitalization. No major difference was identified in lymphocyte count between admission and the last day of hospitalization in both deceased and recovered COVID-19 patients during Delta and Omicron waves. Moreover, patients admitted in the Omicron wave had less severe disease compared to those admitted in the Delta wave. The Kaplan-Meier analysis revealed no significant difference in survival rates or the probability of respiratory failure between six successive COVID-19 waves.
Taken together, our results showed marked differences in the alteration of nonspecific inflammation and damage in the adaptive immune response during the six serial SARS-CoV-2 waves. Considering the inflammatory response of infectious diseases, embedding inflammatory indices informative markers into routine clinical testing offers the potential to mitigate the impact of future pandemics of COVID-19 and other infectious diseases. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| ISSN: | 1567-5769 1878-1705 |
| DOI: | 10.1016/j.intimp.2023.110836 |