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Clinical and pathological investigation of patients with severe COVID-19
- Source :
- JCI Insight
- Publication Year :
- 2020
- Publisher :
- American Society for Clinical Investigation, 2020.
-
Abstract
- BACKGROUND. Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), has become a pandemic. This study addresses the clinical and immunopathological characteristics of severe COVID-19. METHODS. Sixty-nine patients with COVID-19 were classified into severe and nonsevere groups to analyze their clinical and laboratory characteristics. A panel of blood cytokines was quantified over time. Biopsy specimens from 2 deceased cases were obtained for immunopathological, ultrastructural, and in situ hybridization examinations. RESULTS. Circulating cytokines, including IL-8, IL-6, TNF-α, IP10, MCP1, and RANTES, were significantly elevated in patients with severe COVID-19. Dynamic IL-6 and IL-8 were associated with disease progression. SARS-CoV-2 was demonstrated to infect type II and type I pneumocytes and endothelial cells, leading to severe lung damage through cell pyroptosis and apoptosis. In severe cases, lymphopenia, neutrophilia, depletion of CD4(+) and CD8(+) T lymphocytes, and massive macrophage and neutrophil infiltrates were observed in both blood and lung tissues. CONCLUSIONS. A panel of circulating cytokines could be used to predict disease deterioration and inform clinical interventions. Severe pulmonary damage was predominantly attributed to both cytopathy caused by SARS-CoV-2 and immunopathologic damage. Strategies that prohibit pulmonary recruitment and overactivation of inflammatory cells by suppressing cytokine storm might improve the outcomes of patients with severe COVID-19.
- Subjects :
- Male
0301 basic medicine
Biopsy
CD8-Positive T-Lymphocytes
medicine.disease_cause
0302 clinical medicine
Medicine
Chemokine CCL5
Lung
Chemokine CCL2
Coronavirus
medicine.diagnostic_test
Pyroptosis
General Medicine
Middle Aged
medicine.anatomical_structure
Pulmonology
030220 oncology & carcinogenesis
Disease Progression
Cytokines
Female
medicine.symptom
Coronavirus Infections
Research Article
Adult
China
medicine.medical_specialty
Pneumonia, Viral
macromolecular substances
Betacoronavirus
03 medical and health sciences
Lymphopenia
Internal medicine
Humans
Lymphocyte Count
Pandemics
Aged
SARS-CoV-2
business.industry
COVID-19
Endothelial Cells
medicine.disease
Neutrophilia
030104 developmental biology
Immunology
business
Cytokine storm
CD8
Subjects
Details
- ISSN :
- 23793708
- Volume :
- 5
- Database :
- OpenAIRE
- Journal :
- JCI Insight
- Accession number :
- edsair.doi.dedup.....4b415eded105a3e4d801f6ae2c2f7090