UBC Faculty Research and Publications
The Association of Inflammatory Cytokines in the Pulmonary Pathophysiology of Respiratory Failure in Critically Ill Patients With Coronavirus Disease 2019 Stukas, Sophie; Hoiland, Ryan; Cooper, Jennifer; Thiara, Sonny; Griesdale, Donald E.; Thomas, Adam D.; Orde, Matthew M.; English, John C.; Chen, Luke; Foster, Denise; Mitra, Anish; Romano, Kali; Sweet, David; Ronco, Juan J.; Kanji, Hussein; Chen, Yu-Wei R.; Wong, Sophia; Wellington, Cheryl; Sekhon, Mypinder S.
Objectives: The majority of coronavirus disease 2019 mortality and morbidity is attributable to respiratory failure from severe acute respiratory syndrome coronavirus 2 infection. The pathogenesis underpinning coronavirus disease 2019-induced respiratory failure may be attributable to a dysregulated host immune response. Our objective was to investigate the pathophysiological relationship between proinflammatory cytokines and respiratory failure in severe coronavirus disease 2019. Design: Multicenter prospective observational study. Setting: ICU. Patients: Critically ill patients with coronavirus disease 2019 and noncoronavirus disease 2019 critically ill patients with respiratory failure (ICU control group). Interventions: Daily measurement of serum inflammatory cytokines. Measurements and Main Results: Demographics, comorbidities, clinical, physiologic, and laboratory data were collected daily. Daily serum samples were drawn for measurements of interleukin1β, interleukin-6, interleukin-10, and tumor necrosis factor-α. Pulmonary outcomes were the ratio of Pao₂/Fio₂ and static lung compliance. Twenty-six patients with coronavirus disease 2019 and 22 ICU controls were enrolled. Of the patients with coronavirus disease 2019, 58% developed acute respiratory distress syndrome, 62% required mechanical ventilation, 12% underwent extracorporeal membrane oxygenation, and 23% died. A negative correlation between interleukin-6 and Pao₂/Fio₂ (rho, –0.531; p = 0.0052) and static lung compliance (rho, –0.579; p = 0.033) was found selectively in the coronavirus disease 2019 group. Diagnosis of acute respiratory distress syndrome was associated with significantly elevated serum interleukin-6 and interleukin-1β on the day of diagnosis. Conclusions: The inverse relationship between serum interleukin-6 and Pao₂/Fio₂ and static lung compliance is specific to severe acute respiratory syndrome coronavirus 2 infection in critically ill patients with respiratory failure. Similar observations were not found with interleukin-β or tumor necrosis factor-α.
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