Journal
INTERNATIONAL JOURNAL OF MEDICAL SCIENCES
Volume 18, Issue 1, Pages 29-41Publisher
IVYSPRING INT PUBL
DOI: 10.7150/ijms.49728
Keywords
COVID-19; interleukin-6; pulmonary injury; chest CT; sequential monitoring
Categories
Funding
- Chinese National 13th-five-year plan on Key Infectious diseases [2018ZX10302103-002, 2017ZX10202102-003-004]
- Major Project of Collaborative Innovation in Health and Medicine of Guangzhou Science and Technology Innovation Committee [201803040002]
- Guangzhou basic research program on people's Livelihood Science and technology [202002020005]
- Novel Coronavirus disease prevention and control project of Guangdong Province [2020B111105001]
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This study evaluated the dynamic changes of immunological and radiographic features in COVID-19 patients, finding that severe patients had decreased lymphocyte counts, increased neutrophils, and elevated IL-6 levels. Prolonged elevation of IL-6 was associated with persistent pulmonary lesions in these patients, suggesting that monitoring and intervention of IL-6 may benefit the clinical management of COVID-19.
Rationale: Previous studies of coronavirus disease 2019 (COVID-19) were mainly focused on cross-sectional analysis. In this study, we sought to evaluate the dynamic changes of immunological and radiographic features, and the association with the outcome of pulmonary lesions in COVID-19 patients. Methods: Peripheral blood samples and radiographic data were collected longitudinally for up to 8 weeks from 158 laboratory-confirmed COVID-19 patients. The chest computed tomography (CT) scans were scored based on a semi-quantification assessment according to the extent of pulmonary abnormalities; the temporal change of the immunological and radiographic features was analyzed. Results: Compared with mild and moderate patients, severe patients had significantly decreased counts of lymphocytes, CD4+ T cells, CD8+ T cells, and CD19+ B cells but dramatically elevated counts of neutrophils and levels of interleukin (IL)-6. Sequential monitoring showed a sustained increase in lymphocytes counts and significantly decreased levels of IL-6 in severe patients during the disease course. Notably, patients with persistent pulmonary lesions (CT score 5 in week 8) showed high levels of IL-6 during the follow-up period, compared with those with recovery lesions (CT score < 5 in week 8). More importantly, the peak expression of IL-6 prior to the aggravated lung injury was mainly found in patients with persistent lesions, and multivariate analysis showed that IL-6 level upon admission was an independent factor associated with the persistent pulmonary injury. Conclusion: Prolonged elevation of IL-6 is associated with persistent pulmonary lesions in COVID-19 patients. Sequential monitoring and timely intervention of IL-6 may favor the clinical management of COVID-19.
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