key: cord-0729492-rauts83h
authors: Bagate, François; Maziers, Nicolas; Hue, Sophie; Masi, Paul; Mekontso Dessap, Armand; de Prost, Nicolas
title: Serum cytokines profile of critically ill COVID-19 patients with cardiac dysfunction
date: 2021-01-18
journal: Intensive Care Med Exp
DOI: 10.1186/s40635-021-00368-w
sha: fbefc3709cdebaa1906cae76d8a433871009be8d
doc_id: 729492
cord_uid: rauts83h

nan

Additional file 2: Table S1 shows the characteristics of the 34 consecutive patients included in this study cohort, four of whom had previously known moderate LVEF dysfunction (i.e., between 35 and 50%). The first plan of the PCA accounted for 46.2% of inertia, thus almost half the total variance or inertia, and was mainly driven, among the 19 serum cytokine assays, by three of them, involved in the innate immune response (i.e., IL-10, GM-CSF and CXCL10/IP-10), which were highly correlated between each other and thus formed a coherent cytokine group (Fig. 1a) . Moreover, this data partitioning built on the immunological phenotyping at ICU admission was significantly, and independently, connected to LVEF tertiles categorization (Fig. 1b ) (tertile 1: hypokinetic patients, LVEF between 28 and 55%; tertile 2: normokinetic patients, LVEF 55-67%; tertile 3: hyperkinetic patients, LVEF 67-80%), indicating that patients with different values of LVEF had contrasted serum cytokines profiles.

We herein showed that there were three distinct serum cytokines patterns according to cardiac function, as assessed by LVEF, in critically ill COVID-19 patients. Interestingly, LVEF tertiles were also significantly associated with blood troponin levels (Additional file 3: Fig S1) , highlighting a global association between serum cytokines profiles, cardiac dysfunction and troponin elevation. The finding of an IP-10, IL-10, and GM-CSF signature highlights the contribution of myeloid cells to pathogenic inflammation, as previously reported [5] . Such inflammation may amplify an auto-inflammatory loop leading not only to lung, but also myocardial, injury. Further studies, including myocardial tissue and cardiac magnetic resonance studies, are needed to assess the contribution of associated acute myocarditis lesions. Our study highlights the potentially pathogenic association between serum cytokines profiles and myocardial injury in critically ill COVID-19 patients. However, because up to 29% of patients with severe SARS-CoV-2 infection and cardiac dysfunction have a history of coronary heart disease [6] , we cannot exclude that a substantial proportion of our patients had a previously unknown heart failure. Our study has a number of limitations related to the small number of patients included and the lack of a non-COVID-19 control group, making the results only exploratory. In conclusion, our results establish a link between serum cytokines profiles and LVEF in patients with severe SARS-CoV-2 infection, but do not allow for causal inferences to be drawn regarding the mechanisms at play.

Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan China

Description and proposed management of the acute COVID-19 cardiovascular syndrome

Cardiac injury associated with severe disease or ICU admission and death in hospitalized patients with COVID-19: a meta-analysis and systematic review

Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China

Uncontrolled innate and impaired adaptive immune responses in patients with COVID-19 ARDS

Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan

We are very indebted to all physicians and nurses of Henri Mondor medical Intensive Care Unit for their good hand in providing care to COVID-19 patients. 1 

The online version contains supplementary material available at https ://doi.org/10.1186/s4063 5-021-00368 -w.

Additional file 2: Table S1 . Clinical characteristics of 34 critically ill COVID-19 patients, according to left ventricle ejection fraction (LVEF) tertiles. 

The present study has been conducted without any financial support.

All data generated and analyzed during the study are included in the published article and can be shared upon request. All authors helped to revise the draft of the manuscript. All authors read and approved the final manuscript. The study has received the approbation of an institutional review board (Comité de Protection des Personnes Ile de France II; reference number: 3675-NI). Informed consent was obtained from all patients or their relatives.

Not applicable.

The authors declare that they have no competing interests.