Zakeri, R;
Pickles, A;
Carr, E;
Bean, DM;
O'Gallagher, K;
Kraljewic, Z;
Searle, T;
... Bendayan, R; + view all
(2021)
Biological responses to COVID-19: Insights from physiological and blood biomarker profiles.
Current Research in Translational Medicine
, 69
(2)
, Article 103276. 10.1016/j.retram.2021.103276.
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Abstract
Background: Understanding the spectrum and course of biological responses to coronavirus disease 2019 (COVID-19) may have important therapeutic implications. We sought to characterise biological responses among patients hospitalised with severe COVID-19 based on serial, routinely collected, physiological and blood biomarker values. Methods and findings: We performed a retrospective cohort study of 1335 patients hospitalised with laboratory-confirmed COVID-19 (median age 70 years, 56 % male), between 1st March and 30th April 2020. Latent profile analysis was performed on serial physiological and blood biomarkers. Patient characteristics, comorbidities and rates of death and admission to intensive care, were compared between the latent classes. A five class solution provided the best fit. Class 1 “Typical response” exhibited a moderately elevated and rising C-reactive protein (CRP), stable lymphopaenia, and the lowest rates of 14-day adverse outcomes. Class 2 “Rapid hyperinflammatory response” comprised older patients, with higher admission white cell and neutrophil counts, which declined over time, accompanied by a very high and rising CRP and platelet count, and exibited the highest mortality risk. Class 3 “Progressive inflammatory response” was similar to the typical response except for a higher and rising CRP, though similar mortality rate. Class 4 “Inflammatory response with kidney injury” had prominent lymphopaenia, moderately elevated (and rising) CRP, and severe renal failure. Class 5 “Hyperinflammatory response with kidney injury” comprised older patients, with a very high and rising CRP, and severe renal failure that attenuated over time. Physiological measures did not substantially vary between classes at baseline or early admission. Conclusions and relevance: Our identification of five distinct classes of biomarker profiles provides empirical evidence for heterogeneous biological responses to COVID-19. Early hyperinflammatory responses and kidney injury may signify unique pathophysiology that requires targeted therapy.
| Type: | Article |
|---|---|
| Title: | Biological responses to COVID-19: Insights from physiological and blood biomarker profiles |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.retram.2021.103276 |
| Publisher version: | http://dx.doi.org/10.1016/j.retram.2021.103276 |
| Language: | English |
| Additional information: | This version is the version of record. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Biomarkers, Classes, Inflammation, SARS-CoV-2, NEUTROPENIA |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics > Clinical Epidemiology |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10132479 |
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