Immunological sub-phenotypes and response to convalescent plasma in COVID-19 induced ARDS: a secondary analysis of the CONFIDENT trial.

Autor: Misset B; Department of Intensive Care Medicine, Liège University, CHU de Liège, Liege, Belgium. benoit.misset@chuliege.be.; Department of Intensive Care Medicine, University Hospital of Liège, Domaine Universitaire du Sart-Tilman, 4000, Liège, Belgium. benoit.misset@chuliege.be., Diep AN; Biostatistic Unit, Public Health Department, Liège University, Liege, Belgium., Bertrand A; Department of Intensive Care Medicine, Liège University, CHU de Liège, Liege, Belgium., Piagnerelli M; Department of Intensive Care Medicine, Marie-Curie University Hospital, Université Libre de Bruxelles, Charleroi, Belgium., Hoste E; Department of Intensive Care Medicine, University Hospital, Ghent, Belgium., Michaux I; Department of Intensive Care, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium., De Waele E; Department of Clinical Nutrition, Vrije Universiteit Brussel Brussels University Hospital, Jette, Belgium., Dumoulin A; Department of Intensive Care Medicine, Delta General Hospital, Roeselare, Belgium., Jorens PG; Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, LEMP, Edegem, Belgium., van der Hauwaert E; Department of Intensive Care Medicine, Imelda General Hospital, Bonheiden, Belgium., Vallot F; Department of Intensive Care Medicine, Wallonie Picarde General Hospital, Tournai, Belgium., Swinnen W; Department of Intensive Care Medicine, Sint Blasius General Hospital, Dendermonde, Belgium., De Schryver N; Department of Intensive Care Medicine, Saint-Pierre Medical Clinic, Ottignies, Belgium., de Mey N; Department of Intensive Care Medicine, OLV General Hospital, Aalst, Belgium., Layios N; Department of Intensive Care Medicine, Liège University, CHU de Liège, Liege, Belgium., Mesland JB; Department of Intensive Care Medicine, Saint-Luc University Hospital, Brussels, Belgium., Robinet S; Department of Intensive Care Medicine, Liège University, CHU de Liège, Liege, Belgium., Cavalier E; Department of Clinical Chemistry, University of Liege, CIRM, CHU de Liège, Liege, Belgium., Donneau AF; Biostatistic Unit, Public Health Department, Liège University, Liege, Belgium., Moutschen M; Department of Infectious Diseases, CHU de Liège, Liege, Belgium., Laterre PF; Department of Intensive Care Medicine, Mons-Hainaut Regional Hospital, Mons, Belgium.
Jazyk: angličtina
Zdroj: Annals of intensive care [Ann Intensive Care] 2024 Oct 21; Vol. 14 (1), pp. 160. Date of Electronic Publication: 2024 Oct 21.
DOI: 10.1186/s13613-024-01392-1
Abstrakt: Background: Convalescent plasma (CP) reduced the mortality in COVID-19 induced ARDS (C-ARDS) patients treated in the CONFIDENT trial. As patients are immunologically heterogeneous, we hypothesized that clusters may differ in their treatment responses to CP.
Methods: We measured 20 cytokines, chemokines and cell adhesion markers using a multiplex technique at the time of inclusion in the CONFIDENT trial in patients of centers having accepted to participate in this secondary study. We performed descriptive statistics, unsupervised hierarchical cluster analysis, and examined the association between the clusters and CP effect on day-28 mortality.
Results: Of the 475 patients included in CONFIDENT, 391 (82%) were sampled, and 196/391 (50.1%) had been assigned to CP. We identified four sub-phenotypes representing 89 (22.8%), 178 (45.5%), 38 (9.7%), and 86 (22.0%) patients. The most contributing biomarkers in the principal component analysis were IL-1β, IL-12p70, IL-6, IFN-α, IL-17A, IFN-γ, IL-13, TFN-α, total IgG, and CXCL10. Sub-phenotype-1 displayed a lower immune response, sub-phenotype-2 a higher adaptive response, sub-phenotype-3 the highest innate antiviral, pro and anti-inflammatory response, and adhesion molecule activation, and sub-phenotype-4 a higher pro and anti-inflammatory response, migration protein and adhesion molecule activation. Sub-phenotype-2 and sub-phenotype-4 had higher severity at the time of inclusion. The effect of CP treatment on mortality appeared higher than standard care in each sub-phenotype, without heterogeneity between sub-phenotypes (p = 0.97).
Conclusion: In patients with C-ARDS, we identified 4 sub-phenotypes based on their immune response. These sub-phenotypes were associated with different clinical profiles. The response to CP was similar across the 4 sub-phenotypes.
Trial Registration: Ethics Committee of the University Hospital of Liège CE 2020/239.
Clinicaltrials: gov NCT04558476. Registered 2020-09-11, https://www.
Clinicaltrials: gov/study/NCT04558476 .
(© 2024. The Author(s).)
Databáze: MEDLINE
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