Longitudinal Characterization of Cytokine Overproduction: A Case Report in Critically Ill COVID-19 Patients With Hyperinflammation in Bronchoalveolar Lavage

Zhen Luo; Chengliang Zhu; Zhihui Ruan; Xianghua Cui; Muhammad Adnan Shereen; Pan Pan; Jingtao Huang; Fubing Wang; Hanwen Su; Yuchen Xia; Jianguo Wu

doi:10.3389/fmed.2021.690523

Longitudinal Characterization of Cytokine Overproduction: A Case Report in Critically Ill COVID-19 Patients With Hyperinflammation in Bronchoalveolar Lavage

Front Med (Lausanne). 2021 Sep 7:8:690523. doi: 10.3389/fmed.2021.690523. eCollection 2021.

Authors

Zhen Luo¹, Chengliang Zhu², Zhihui Ruan¹, Xianghua Cui², Muhammad Adnan Shereen³, Pan Pan¹, Jingtao Huang², Fubing Wang⁴, Hanwen Su², Yuchen Xia⁵, Jianguo Wu^{1

3}

Affiliations

¹ Guangdong Provincial Key Laboratory of Virology, Institute of Medical Microbiology, Jinan University, Guangzhou, China.
² Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China.
³ State Key Laboratory of Virology, College of Life Science, Wuhan University, Wuhan, China.
⁴ Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
⁵ State Key Laboratory of Virology, School of Basic Medical Sciences, Wuhan University, Wuhan, China.

Abstract

Objectives: The longitudinal characterization and risk of poor outcomes related to cytokine overproduction in critical coronavirus disease 2019 (COVID-19) patients with hyperinflammation in bronchoalveolar lavage requires further investigation. Methods: We enrolled two critically ill patients with comorbidities diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detected by RT-PCR during hospitalization. Clinical characteristics, longitudinal immunological, and biochemical parameters of each critical COVID-19 case were collected. Main Results: The clinical characteristics and laboratory results of each case demonstrated critical symptoms of COVID-19 with poor outcomes. Both nasopharyngeal swabs and bronchoalveolar lavage fluid (BALF) samples tested positive for SARS-CoV-2. Two patients received targeted treatments against pathogen infection and inflammation in addition to interventional therapies, except for Patient 2, who received an additional artificial liver system treatment. Hyperinflammation with a dominantly high level of IL-6 was observed in BALF samples from both critical cases with decreased T cell populations. High levels of cytokines and pathological parameters were successively maintained in Patient 1, but rapidly reduced at the late treatment stage in Patient 2. The outcome of Patient 1 is death, whereas the outcome of Patient 2 is recovery. Conclusions: This case report suggests that a high risk of poor outcomes was related to a heavily hyperinflammatory milieu in both the blood and lungs of critical COVID-19 patients. The artificial liver intervention on cytokines overproduction might be beneficial for the recovery of critical COVID-19 patients as a reliable therapy that can be coordinated with targeted treatments, which ought to be further tested in adequately designed and powered clinical trials.

Keywords: COVID-19; SARS-CoV-2; bronchoalveolar lavage fluid; cytokine overproduction; hyperinflammation; poor outcomes.

Publication types

Case Reports