Biological responses to COVID-19: Insights from physiological and blood biomarker profiles

Understanding the spectrum and course of biological responses to coronavirus disease 2019 (COVID-19) may have important therapeutic implications. We sought to characterise biological responses among patients hospitalised with severe COVID-19 based on serial, routinely collected, physiological and bl...

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Bibliographic Details
Published in:	Current research in translational medicine Vol. 69; no. 2; p. 103276
Main Authors:	Zakeri, Rosita, Pickles, Andrew, Carr, Ewan, Bean, Daniel M., O’Gallagher, Kevin, Kraljewic, Zeljko, Searle, Tom, Shek, Anthony, Galloway, James B, Teo, James T.H., Shah, Ajay M., Dobson, Richard J.B., Bendayan, Rebecca
Format:	Journal Article
Language:	English
Published:	France Elsevier Masson SAS 01-05-2021 Published by Elsevier Masson SAS
Subjects:	Aged Aged, 80 and over Biological Variation, Individual Biomarkers Biomarkers - blood Body Temperature Classes Cohort Studies Comorbidity COVID-19 - blood COVID-19 - diagnosis COVID-19 - epidemiology COVID-19 - physiopathology Diagnostic Tests, Routine Disease Progression Female Heart Rate - physiology Humans Inflammation Male Middle Aged Original Oxygen Consumption - physiology Prognosis Retrospective Studies Risk Assessment SARS-CoV-2 SARS-CoV-2 - immunology SARS-CoV-2 - pathogenicity Severity of Illness Index Socioeconomic Factors United Kingdom - epidemiology United Kingdom CRP SBP IHD BAME Inflammation EHR COVID-19 SARS-CoV-2 DBP NLP REML RT-PCR Biomarkers ICU CKD ARDS HF COPD Classes
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Summary:	Understanding the spectrum and course of biological responses to coronavirus disease 2019 (COVID-19) may have important therapeutic implications. We sought to characterise biological responses among patients hospitalised with severe COVID-19 based on serial, routinely collected, physiological and blood biomarker values. We performed a retrospective cohort study of 1335 patients hospitalised with laboratory-confirmed COVID-19 (median age 70 years, 56 % male), between 1st March and 30th April 2020. Latent profile analysis was performed on serial physiological and blood biomarkers. Patient characteristics, comorbidities and rates of death and admission to intensive care, were compared between the latent classes. A five class solution provided the best fit. Class 1 “Typical response” exhibited a moderately elevated and rising C-reactive protein (CRP), stable lymphopaenia, and the lowest rates of 14-day adverse outcomes. Class 2 “Rapid hyperinflammatory response” comprised older patients, with higher admission white cell and neutrophil counts, which declined over time, accompanied by a very high and rising CRP and platelet count, and exibited the highest mortality risk. Class 3 “Progressive inflammatory response” was similar to the typical response except for a higher and rising CRP, though similar mortality rate. Class 4 “Inflammatory response with kidney injury” had prominent lymphopaenia, moderately elevated (and rising) CRP, and severe renal failure. Class 5 “Hyperinflammatory response with kidney injury” comprised older patients, with a very high and rising CRP, and severe renal failure that attenuated over time. Physiological measures did not substantially vary between classes at baseline or early admission. Our identification of five distinct classes of biomarker profiles provides empirical evidence for heterogeneous biological responses to COVID-19. Early hyperinflammatory responses and kidney injury may signify unique pathophysiology that requires targeted therapy.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 These authors contributed equally.
ISSN:	2452-3186 2452-3186
DOI:	10.1016/j.retram.2021.103276