Avaliação do perfil imunoinflamatório sérico em idosos hospitalizados com covid-19 grave

Abstract

Coronavirus disease 2019 (COVID-19) is one of the main emerging serious respiratory diseases in humans, being recognized as a pandemic by the World Health Organization (WHO) in March 2020. The pandemic has highlighted the elderly vulnerability, especially those above 75 years, who are more likely to develop severe disease and progress to death. Numerous studies have outlined the action of SARS-CoV-2 pathogenesis with the induction of cytokine and chemokine storm during the progressive infection phase as a result of an uncontrolled systemic inflammatory response in senescence. The study of new immunoinflammatory biomarkers in the elderly is essential to assist in the outcome of the prognosis in a timely manner and in the management of these patients. Therefore, this study aimed to perform an analysis of the serum immunoinflammatory profile in hospitalized elderly people diagnosed with severe COVID-19. An observational, longitudinal, and prospective cohort study was carried out at the Metropolitan Hospital Dom José Maria Pires, between June and August 2020. The study includes 92 patients with clinical evolution to hospital admission diagnosed with COVID-19 by RT-PCR test, classified as severe or critics. Elderly males over 60 years old (mean 67.14) were the most severely affected, as evidenced by the significantly high morbidity and mortality in this group. IL-17A and the chemokine CXCL9 were the most prominent biomarkers correlated with the disease progression among the clinical presentations of the infection addressed in this study. In addition, lower CXCL9 chemokine levels in patients who died are positively correlated with LNR. Similar profiles to this study of pro-inflammatory cytokines were observed by other researchers, whose elevation of IL-17 had an AUC of 0.926, indicating a very good ability to distinguish between severe and mild cases of COVID-19. Based on the predictive and prognostic values of the immunoinflammatory profile, IL-17 A and CXCL9 should be included in routine clinical trials of patients with COVID-19. Since these biomarkers can be an excellent tool to help elucidate the pathogenesis of the disease, diagnosis, and prognosis, assisting in the clinical management of patients with COVID-19, contribute significantly to the reduction of morbidity and mortality.