Increased serum levels of soluble TNF-α receptor is associated with mortality of ICU COVID-19 patients

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) has spread to almost 100 countries, infected over 10M patients and resulted in 505K deaths worldwide as of 30th June 2020. The major clinical feature of severe COVID-19 requiring ventilation is acute Respiratory Distress Syndrome (ARDS) with multi-functional failure as a result of a cytokine storm with increased serum levels of cytokines such as TNF- and IL-6 being reported. TNF- levels are increased during the cytokine storm in very ill patients and soluble receptors for IL-6 and IL-2 are present in the blood of COVID-19 patients, ObjectivesTo elucidate the involvement of serum levels of soluble TNF-Receptor of severe and mild COVID-19 patients to determine for severity of disease. MethodWe recruited16 severe COVID-19 patients in the ICU on ventilator support and 26 milder COVID-19 patients who were hospitalised but not within the intensive care unit (ICU) between March-May 2020 at the Masih Daneshvari Hospital Tehran, Iran. After harvesting of whole blood the serum was isolated and soluble TNF-Receptor levels measured by ELISA. ResultsSerum levels of the usually inhibitory soluble TNF- receptor 1 (sTNFR1) were significantly elevated in severe COVID-19 patients at admission to ICU. High serum levels of sTNFR1 were associated with mortality of severe COVID-19 patients treated within ICU. ConclusionsThis pilot study demonstrates for role of STNF-R1 receptor in severity of disease. Future studies should examine whether lower levels of systemic sTNFR1 at admission may indicate a better disease outcome.

Factors associated with death or intensive care unit admission due to pandemic 2009 influenza A (H1N1) infection.

BACKGROUND: In preparation for pandemic HINI or H1N1 influenza (H1N1) it is necessary to identify factors associated with mortality of patients with HINI and hospital admissions to intensive care unit (ICU) of patients diagnosed in 2009 with HINI. OBJECTIVES: To describe the clinical and epidemiological features associated with 2009 HIN1 mortality and ICU patient admissions to Masih Daneshvari Teaching Hospital, Iran. METHODS: A retrospective cross-sectional study was conducted among patients with mortality and admissions to ICU with confirmed HINI. Demographic, clinical, laboratory, radiological findings, and epidemiologic data were abstracted from medical records, using a standardized datasheet. RESULTS: From June through December 2009, 20 out of the 46 confirmed hospitalized patients with confirmed H1NI were admitted to the ICU and 7 (15%) died. Among various variables, opium inhalation (P = 0.01), having productive cough, hemoptysis, chest pain, confusion, and loss of consciousness were significantly related to ICU admission (P < 0.05). Pleural effusion (P = 0.006), elevated liver enzymes, as well as CPK and LDH level were significantly relevant to ICU admission (P < 0.05). Delayed antiviral treatment was more common among patients who died and the elderly. DISCUSSION: Patients who were admitted to ICU with confirmed H1N1 included the following risk factors: delayed initiation of antiviral therapy, history of opium inhalation and symptoms including; productive cough, hemoptysis, chest pain, confusion, and loss of consciousness. The mortality rate in the study population was high but compares favorably with other recent published studies.