TY - JOUR
T1 - Low BALF CD4 T cells count is associated with extubation failure and mortality in critically ill covid-19 pneumonia
AU - Singh, Gurmeet
AU - Martin Rumende, Cleopas
AU - Sharma, Surendra K.
AU - Rengganis, Iris
AU - Amin, Zulkifli
AU - Loho, Tonny
AU - Hermiyanti, Emmy
AU - Harimurti, Kuntjoro
AU - Wibowo, Heri
N1 - Funding Information:
The authors thank all patients and their families, and healthcare workers involved in this study who with full encouragement are consistently providing care for patients in COVID-19 pandemic. Special thanks to Dita Aditianingsih, MD, Adhrie Sugiarto, MD, and Sidharta Kusuma Manggala, MD (Intensivists); Dewi Wulandari, MD, Eka (Clinical Pathologists); Saras and team (Integrated Laboratory Medical Faculty, Universitas Indonesia); Hadiki Habib, MD and Fidiaji Toni, MD (Internists/Emergency physicians); I Putu Eka Krishna Wijaya, MD, Ahmad Nur Aulia, MD, Nova Bornida Fauzi, MD, Muhammad Adriyanto, MD, Sudirman Fakhruddin Masse, MBBS and Indah Septiani (Division of Respirology and Critical Illness, Internal Medicine Department); Utami (Research Co-ordinator unit) for their contributions in conducting this study. Registration : The study was registered at UMIN Clinical Trials Registry (UMIN-CTR) (registration number UMIN000046236, last modified date: 2022/04/18), accessible at: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000049197
Publisher Copyright:
© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
PY - 2022
Y1 - 2022
N2 - Background: Critically ill COVID-19 pneumonia is one of the main causes of extubation failure and mortality. Understanding clinical characteristics, laboratory profiles and bronchoalveolar lavage fluid (BALF) immunopathology may help improve outcomes in critically ill COVID-19 pneumonia. We aimed to describe clinical characteristics, laboratory profiles and BALF immunopathology based on lung severity in critically ill COVID-19 pneumonia patients. Materials and methods: Forty critically ill severe pneumonia patients requiring invasive mechanical ventilation in Cipto Mangunkusumo General (National Tertiary Referral Hospital), Indonesia within November 2020–January 2021 were enrolled in this study. Early BALF collection was performed after patients’ intubation. Clinical characteristics, laboratory profiles and BALF biomarkers (sTREM-1, alveolar macrophage amount and function, IL-6, IL-17, CD4 T-cells, Tregs, SP-A and Caspase-3) were observed and analysed. Outcomes were measured based on extubation failure (within 19 days) and 28-days mortality. Univariate and bivariate analyses were performed. Results: Early bronchoscopy was performed in an average of 4 h (SD = 0.82) after patients’ intubation. Twenty-three and twenty-two patients had extubation failure (within 19 days) and 28-days mortality, respectively. In the baseline clinical characteristics of critically ill COVID-19 patients, we found no significant differences in the extubation and mortality status groups. In the laboratory profiles of critically ill COVID-19 patients, we found no significant differences in the extubation status groups. In critically ill COVID-19 pneumonia patients, there was a significant high D-dimer levels in survived group (p =.027), a significant low BALF CD4 T-cells count in the right lung (p =.001) and a significant low BALF CD4 T-cells count (p =.010 and p =.018) in severely affected lung with extubation failure and mortality. Conclusions: BALF CD4 T-cells count evaluation of severely affected lung is associated with early extubation failure and mortality in critically ill COVID-19 pneumonia patients. KEY MESSAGE Few studies have been conducted during the peak COVID-19 period analysing combined bronchoalveolar lavage fluid (BALF) immunopathology biomarkers within four hours of intubation to assess extubation failure and mortality. In this study, we reported eight BALF immunopathology biomarkers (sTREM-1, alveolar macrophage, IL-6, IL-17, CD4 T-cells, Tregs, SP-A and Caspase-3). We found significantly low BALF CD4 T-cells count in the right lung, and low BALF CD4 T-cells count in severely affected lung of critically ill COVID-19 pneumonia patients in extubation failure and mortality.
AB - Background: Critically ill COVID-19 pneumonia is one of the main causes of extubation failure and mortality. Understanding clinical characteristics, laboratory profiles and bronchoalveolar lavage fluid (BALF) immunopathology may help improve outcomes in critically ill COVID-19 pneumonia. We aimed to describe clinical characteristics, laboratory profiles and BALF immunopathology based on lung severity in critically ill COVID-19 pneumonia patients. Materials and methods: Forty critically ill severe pneumonia patients requiring invasive mechanical ventilation in Cipto Mangunkusumo General (National Tertiary Referral Hospital), Indonesia within November 2020–January 2021 were enrolled in this study. Early BALF collection was performed after patients’ intubation. Clinical characteristics, laboratory profiles and BALF biomarkers (sTREM-1, alveolar macrophage amount and function, IL-6, IL-17, CD4 T-cells, Tregs, SP-A and Caspase-3) were observed and analysed. Outcomes were measured based on extubation failure (within 19 days) and 28-days mortality. Univariate and bivariate analyses were performed. Results: Early bronchoscopy was performed in an average of 4 h (SD = 0.82) after patients’ intubation. Twenty-three and twenty-two patients had extubation failure (within 19 days) and 28-days mortality, respectively. In the baseline clinical characteristics of critically ill COVID-19 patients, we found no significant differences in the extubation and mortality status groups. In the laboratory profiles of critically ill COVID-19 patients, we found no significant differences in the extubation status groups. In critically ill COVID-19 pneumonia patients, there was a significant high D-dimer levels in survived group (p =.027), a significant low BALF CD4 T-cells count in the right lung (p =.001) and a significant low BALF CD4 T-cells count (p =.010 and p =.018) in severely affected lung with extubation failure and mortality. Conclusions: BALF CD4 T-cells count evaluation of severely affected lung is associated with early extubation failure and mortality in critically ill COVID-19 pneumonia patients. KEY MESSAGE Few studies have been conducted during the peak COVID-19 period analysing combined bronchoalveolar lavage fluid (BALF) immunopathology biomarkers within four hours of intubation to assess extubation failure and mortality. In this study, we reported eight BALF immunopathology biomarkers (sTREM-1, alveolar macrophage, IL-6, IL-17, CD4 T-cells, Tregs, SP-A and Caspase-3). We found significantly low BALF CD4 T-cells count in the right lung, and low BALF CD4 T-cells count in severely affected lung of critically ill COVID-19 pneumonia patients in extubation failure and mortality.
KW - BALF CD4 T-cells count
KW - Critically ill COVID-19 pneumonia
KW - extubation failure
UR - http://www.scopus.com/inward/record.url?scp=85133239203&partnerID=8YFLogxK
U2 - 10.1080/07853890.2022.2095012
DO - 10.1080/07853890.2022.2095012
M3 - Article
C2 - 35786088
AN - SCOPUS:85133239203
SN - 0785-3890
VL - 54
SP - 1894
EP - 1905
JO - Annals of Medicine
JF - Annals of Medicine
IS - 1
ER -