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Šelb, Julij; Bitežnik, Barbara; Bidovec Stojković, Urška; Rituper, Boštjan; Osolnik, Katarina; Kopač, Peter; Svetina, Petra; Cerk Porenta, Kristina; Šifrer, Franc; Lorber, Petra; Trinkaus Leiler, Darinka; Hafner, Tomaž; Jerič, Tina; Marčun, Robert; Lalek, Nika; Frelih, Nina; Bizjak, Mojca; Lombar, Rok; Nikolić, Vesna; Adamič, Katja; Mohorčič, Katja; Grm Zupan, Sanja; Šarc, Irena; Debeljak, Jerneja; Koren, Ana; Luzar, Ajda Demšar; Rijavec, Matija; Kern, Izidor; Fležar, Matjaž; Rozman, Aleš; Korošec, Peter
ERJ open research, 10/2022, Letnik: 8, Številka: 4Journal Article
The relationship between anti-SARS-CoV-2 humoral immune response, pathogenic inflammation, lymphocytes and fatal COVID-19 is poorly understood. A longitudinal prospective cohort of hospitalised patients with COVID-19 (n=254) was followed up to 35 days after admission (median, 8 days). We measured early anti-SARS-CoV-2 S1 antibody IgG levels and dynamic (698 samples) of quantitative circulating T-, B- and natural killer lymphocyte subsets and serum interleukin-6 (IL-6) response. We used machine learning to identify patterns of the immune response and related these patterns to the primary outcome of 28-day mortality in analyses adjusted for clinical severity factors. Overall, 45 (18%) patients died within 28 days after hospitalisation. We identified six clusters representing discrete anti-SARS-CoV-2 immunophenotypes. Clusters differed considerably in COVID-19 survival. Two clusters, the anti-S1-IgG T B NK IL-6 and the anti-S1-IgG T B NK IL-6 had a high risk of fatal COVID-19 (HR 3.36-21.69; 95% CI 1.51-163.61 and HR 8.39-10.79; 95% CI 1.20-82.67; p≤0.03, respectively). The anti-S1-IgG T B NK IL-6 and anti-S1-IgG T B NK IL-6 cluster were associated with moderate risk of mortality. In contrast, two clusters the anti-S1-IgG T B NK IL-6 and anti-S1-IgG T B NK IL-6 clusters were characterised by a very low risk of mortality. By employing unsupervised machine learning we identified multiple anti-SARS-CoV-2 immune response clusters and observed major differences in COVID-19 mortality between these clusters. Two discrete immune pathways may lead to fatal COVID-19. One is driven by impaired or delayed antiviral humoral immunity, independently of hyper-inflammation, and the other may arise through excessive IL-6-mediated host inflammation response, independently of the protective humoral response. Those observations could be explored further for application in clinical practice.
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JCR | SNIP | JCR | SNIP | JCR | SNIP | JCR | SNIP |
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in: SICRIS
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