Neutrophils-related host factors associated with severe disease and fatality in patients with influenza infection

Nat Commun. 2019 Jul 31;10(1):3422. doi: 10.1038/s41467-019-11249-y.

Abstract

Severe influenza infection has no effective treatment available. One of the key barriers to developing host-directed therapy is a lack of reliable prognostic factors needed to guide such therapy. Here, we use a network analysis approach to identify host factors associated with severe influenza and fatal outcome. In influenza patients with moderate-to-severe diseases, we uncover a complex landscape of immunological pathways, with the main changes occurring in pathways related to circulating neutrophils. Patients with severe disease display excessive neutrophil extracellular traps formation, neutrophil-inflammation and delayed apoptosis, all of which have been associated with fatal outcome in animal models. Excessive neutrophil activation correlates with worsening oxygenation impairment and predicted fatal outcome (AUROC 0.817-0.898). These findings provide new evidence that neutrophil-dominated host response is associated with poor outcomes. Measuring neutrophil-related changes may improve risk stratification and patient selection, a critical first step in developing host-directed immune therapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cell Cycle / immunology
  • Extracellular Traps / immunology*
  • Female
  • Gene Expression / genetics
  • Humans
  • Influenza A Virus, H1N1 Subtype / immunology
  • Influenza A Virus, H1N1 Subtype / isolation & purification
  • Influenza A Virus, H3N2 Subtype / immunology
  • Influenza A Virus, H3N2 Subtype / isolation & purification
  • Influenza B virus / immunology
  • Influenza B virus / isolation & purification
  • Influenza, Human / immunology*
  • Influenza, Human / mortality
  • Influenza, Human / pathology*
  • Lung / immunology
  • Male
  • Middle Aged
  • Neutrophil Activation / immunology*
  • Neutrophils / immunology*
  • Prospective Studies
  • Respiration, Artificial
  • Respiratory Insufficiency / mortality
  • Respiratory Insufficiency / pathology
  • Respiratory Insufficiency / virology