T cell immune response predicts survival in severely ill COVID-19 patients requiring venovenous extracorporeal membrane oxygenation support.

Autor:	Ulakcsai Z; Heart and Vascular Center, Semmelweis University, Budapest, Hungary., Szabo L; Heart and Vascular Center, Semmelweis University, Budapest, Hungary.; William Harvey Research Institute, Queen Mary University of London, London, United Kingdom., Szabo Z; Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary., Karaszi E; Pediatric Healthcare Center, Council of Budafok-Tétény, Budapest, Hungary., Szabo T; Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary., Fazekas L; Heart and Vascular Center, Semmelweis University, Budapest, Hungary., Vereb A; Heart and Vascular Center, Semmelweis University, Budapest, Hungary., Kovacs NF; Heart and Vascular Center, Semmelweis University, Budapest, Hungary., Nemeth D; Department of Rheumatology and Clinical Immunology, Semmelweis University, Budapest, Hungary.; Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary., Kovacs E; Heart and Vascular Center, Semmelweis University, Budapest, Hungary., Nemeth E; Heart and Vascular Center, Semmelweis University, Budapest, Hungary., Nagy G; Heart and Vascular Center, Semmelweis University, Budapest, Hungary.; Department of Rheumatology and Clinical Immunology, Semmelweis University, Budapest, Hungary.; Hospital of the Hospitaller Order of Saint John of God, Budapest, Hungary., Vago H; Heart and Vascular Center, Semmelweis University, Budapest, Hungary.; Department of Sports Medicine, Semmelweis University, Budapest, Hungary., Merkely B; Heart and Vascular Center, Semmelweis University, Budapest, Hungary.; Department of Sports Medicine, Semmelweis University, Budapest, Hungary.
Jazyk:	angličtina
Zdroj:	Frontiers in immunology [Front Immunol] 2023 Aug 01; Vol. 14, pp. 1179620. Date of Electronic Publication: 2023 Aug 01 (Print Publication: 2023).
DOI:	10.3389/fimmu.2023.1179620
Abstrakt:	Introduction: There is a critical gap in understanding which SARS-CoV-2 patients would benefit most from venovenous extracorporeal membrane oxygenation (VV-ECMO) support. The potential role of a dysregulated immune response is still unclear in this patient population. Objectives: To assess the potential predictive value of SARS-CoV-2 specific cellular and humoral immune responses for survival in critically ill COVID-19 patients requiring VV-ECMO. Methods: We conducted a prospective single-center observational study of unvaccinated patients requiring VV-ECMO support treated at the intensive care unit of Semmelweis University Heart and Vascular Center between March and December 2021. Peripheral blood samples were collected to measure the humoral and cellular immune statuses of the patients at the VV-ECMO cannulation. Patients were followed until hospital discharge. Results: Overall, 35 COVID-19 patients (63% men, median age 37 years) on VV-ECMO support were included in our study. The time from COVID-19 verification to ECMO support was a median (IQR) of 10 (7-14) days. Of the patients, 9 (26%) were discharged alive and 26 (74%) died during their hospital stay. Immune tests confirmed ongoing SARS-CoV-2 infection in all the patients, showing an increased humoral immune response. SARS-CoV-2-specific cellular immune response was significantly higher among survivors compared to the deceased patients. A higher probability of survival was observed in patients with markers indicating a higher T cell response detected by both QuantiFeron (QF) and flow cytometry (Flow) assays. (Flow S1 CD8+ ≥ 0.15%, Flow S1 CD4+ ≥ 0.02%, QF CD4 ≥ 0.07, QF whole genome ≥ 0.59). In univariate Cox proportional hazard regression analysis BMI, right ventricular (RV) failure, QF whole genome T cell level, and Flow S1 CD8+ T cell level were associated with mortality, and we found that an increased T cell response showed a significant negative association with mortality, independent of BMI and RV failure. Conclusion: Evaluation of SARS-CoV-2 specific T cell response before the cannulation can aid the risk stratification and evaluation of seriously ill COVID-19 patients undergoing VV-ECMO support by predicting survival, potentially changing our clinical practice in the future. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2023 Ulakcsai, Szabo, Szabo, Karaszi, Szabo, Fazekas, Vereb, Kovacs, Nemeth, Kovacs, Nemeth, Nagy, Vago and Merkely.)
Databáze:	MEDLINE
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