Feedback

Patients with SARS-CoV-2-Induced Viral Sepsis Simultaneously Show Immune Activation, Impaired Immune Function and a Procoagulatory Disease State

ORCID
0000-0002-1524-6180
Affiliation
Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
Limmer, Andreas;
Affiliation
Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
Engler, Andrea;
ORCID
0000-0002-4286-7978
Affiliation
Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
Kattner, Simone;
Affiliation
Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
Gregorius, Jonas;
ORCID
0000-0003-4569-8310
Affiliation
Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
Pattberg, Kevin Thomas;
Affiliation
Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
Schulz, Rebecca;
Affiliation
Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
Schwab, Jansje;
Affiliation
Institute of Immunology, University of Münster, 48149 Münster, Germany
Roth, Johannes;
ORCID
0000-0001-9669-7479
Affiliation
Institute of Immunology, University of Münster, 48149 Münster, Germany
Vogl, Thomas;
ORCID
0000-0001-9502-9903
Affiliation
Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
Krawczyk, Adalbert;
Affiliation
Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
Witzke, Oliver;
Affiliation
Institute of Virology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
Zelinskyy, Gennadiy;
Affiliation
Institute of Virology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
Dittmer, Ulf;
Affiliation
Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
Brenner, Thorsten;
ORCID
0000-0001-6771-3193
Affiliation
Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
Berger, Marc Moritz

Background: It is widely accepted that SARS-CoV-2 causes a dysregulation of immune and coagulation processes. In severely affected patients, viral sepsis may result in life endangering multiple organ dysfunction. Furthermore, most therapies for COVID-19 patients target either the immune system or coagulation processes. As the exact mechanism causing SARS-CoV-2-induced morbidity and mortality was unknown, we started an in-depth analysis of immunologic and coagulation processes. Methods: 127 COVID-19 patients were treated at the University Hospital Essen, Germany, between May 2020 and February 2022. Patients were divided according to their maximum COVID-19 WHO ordinal severity score (WHO 0–10) into hospitalized patients with a non-severe course of disease (WHO 4–5, n = 52) and those with a severe course of disease (WHO 6–10, n = 75). Non-infected individuals served as healthy controls (WHO 0, n = 42). Blood was analyzed with respect to cell numbers, clotting factors, as well as pro- and anti-inflammatory mediators in plasma. As functional parameters, phagocytosis and inflammatory responses to LPS and antigen-specific stimulation were determined in monocytes, granulocytes, and T cells using flow cytometry. Findings: In the present study, immune and coagulation systems were analyzed simultaneously. Interestingly, many severe COVID-19 patients showed an upregulation of pro-inflammatory mediators and at the same time clear signs of immunosuppression. Furthermore, severe COVID-19 patients not only exhibited a disturbed immune system, but in addition showed a pronounced pro-coagulation phenotype with impaired fibrinolysis. Therefore, our study adds another puzzle piece to the already complex picture of COVID-19 pathology implying that therapies in COVID-19 must be individualized. Conclusion: Despite years of research, COVID-19 has not been understood completely and still no therapies exist, fitting all requirements and phases of COVID-19 disease. This observation is highly reminiscent to sepsis. Research in sepsis has been going on for decades, while the disease is still not completely understood and therapies fitting all patients are lacking as well. In both septic and COVID-19 patients, immune activation can be accompanied by immune paralysis, complicating therapeutic intervention. Accordingly, therapies that lower immune activation may cause detrimental effects in patients, who are immune paralyzed by viral infections or sepsis. We therefore suggest individualizing therapies and to broaden the spectrum of immunological parameters analyzed before therapy. Only if the immune status of a patient is understood, can a therapeutic intervention be successful.

Cite

Citation style:
Could not load citation form.

Access Statistic

Total:
Downloads:
Abtractviews:
Last 12 Month:
Downloads:
Abtractviews:

Rights

License Holder: © 2023 by the authors.

Use and reproduction: