ABSTRACT
Background:The hyperinflammatory phenotype of acute respiratory distress syndrome(ARDS) is characterized by elevated proinflammatory cytokines ,an increased incidence of shock ,and adverse clinical outcomes.The characterictics of this phenotype could be considered as most consistent with those expected with the cytokine storm.However, the increased levels of proinflammatory cytokines and their predictive value in bronchoalveolar fluid(BALF) in intubated and survivors patients with COVID19 is unclear.Objective:The aim of this study was to evaluate the cytology and cytokine content of BALF in intubated survivor and non-survivor patients with critically ill COVID19.Method and Measurements: We have enrolled to this stidy 37 intubated patients with critically ill COVID19 complicated with ARDS.All patients have been admitted to the intensive care unit (ICU)department of Hospital Clinic of Medical University ,Baku city.In all patients have investigated daily portable chest X-ray ,biochemistry, immunology spectrum, microbiology of the endotracheal aspirate and BAL, and although proinflammatory cytology and cytokine content of BALF via bronchoscopy.Results:17 (46%) of 37 patients have died in ICU department ,and there were big differences between cytology content of BALF in intubated survivors and non-survivors . The level of the CD4+(%) in BALF was lesser in survivors compared to nonsurvivors( 61.3+-17.5 vs 82.6+-19.4;p<0.01), in contrary to this the level of CD8+(%) in BALF in survivors was higher compared to non-survivors(28.7+-9.5 vs 14,3+-10.4;p<0.05).CD4/CD8 ratio was lesser in survivors compared to non-survivors(5.1+-2.8 vs 8.9+-3.4;p<0.01).Plasma levels of cytokines (IL-6 and IL-8) was higher in non-survivors compared to survivors(IL-6:3986+-1435,pg/ml vs 2453+-987,pg/ml;p<0.001).BALF investigation for cytokine levels reveal markedly differences between survivors and non-survivors.Il-8 level in BALF was less in survivors compared to non-survivors(2478+-1056,pg/ml vs 6698+-1254,pg/ml;p<0.03),the content of IL-6 in BALF although was significantly higher in non-survivors compared to survivors(643+-124,pg/ml vs 219-+-94,pg/ml;p<0.005).High levels of cytokines in BALF and plasma were associated with more higher cilinical features of respiratory failure and more severe ARDS and kidney failure.In our study good predictor for high plasma and BALF levels of proinflammatory cytokines was higher level of Creactive protein.Conclusions:Hyperinflammatory status of patients with COVID19 complicated with ARDS is associated with high levels of proinflammatory cytokines in plasma and BALF .However, more higher levels of proinflammatory cytokines in BALF and plasma are associated with increased mortality in such patients.In intubated patients the identification of cytokine and cell content of BALF may predict the mortality risk of patients with crtically ill COVID19.