Pattern of inflammatory immune response determines the clinical course and outcome of COVID-19: unbiased clustering analysis

Abstract The objective of the study was to identify distinct patterns in inflammatory immune responses of COVID-19 patients and to investigate their association with clinical course and outcome. Data from hospitalized COVID-19 patients were retrieved from electronic medical record. Supervised k-mean...

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Autores principales:	Eunyoung Emily Lee, Kyoung-Ho Song, Woochang Hwang, Sin Young Ham, Hyeonju Jeong, Jeong-Han Kim, Hong Sang Oh, Yu Min Kang, Eun Bong Lee, Nam Joong Kim, Bum Sik Chin, Jin Kyun Park
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/45194ea1576e47ceb5940ef1dd612e28
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spelling	oai:doaj.org-article:45194ea1576e47ceb5940ef1dd612e282021-12-02T14:27:45ZPattern of inflammatory immune response determines the clinical course and outcome of COVID-19: unbiased clustering analysis10.1038/s41598-021-87668-z2045-2322https://doaj.org/article/45194ea1576e47ceb5940ef1dd612e282021-04-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-87668-zhttps://doaj.org/toc/2045-2322Abstract The objective of the study was to identify distinct patterns in inflammatory immune responses of COVID-19 patients and to investigate their association with clinical course and outcome. Data from hospitalized COVID-19 patients were retrieved from electronic medical record. Supervised k-means clustering of serial C-reactive protein levels (CRP), absolute neutrophil counts (ANC), and absolute lymphocyte counts (ALC) was used to assign immune responses to one of three groups. Then, relationships between patterns of inflammatory responses and clinical course and outcome of COVID-19 were assessed in a discovery and validation cohort. Unbiased clustering analysis grouped 105 patients of a discovery cohort into three distinct clusters. Cluster 1 (hyper-inflammatory immune response) was characterized by high CRP levels, high ANC, and low ALC, whereas Cluster 3 (hypo-inflammatory immune response) was associated with low CRP levels and normal ANC and ALC. Cluster 2 showed an intermediate pattern. All patients in Cluster 1 required oxygen support whilst 61% patients in Cluster 2 and no patient in Cluster 3 required supplementary oxygen. Two (13.3%) patients in Cluster 1 died, whereas no patient in Clusters 2 and 3 died. The results were confirmed in an independent validation cohort of 116 patients. We identified three different patterns of inflammatory immune response to COVID-19. Hyper-inflammatory immune responses with elevated CRP, neutrophilia, and lymphopenia are associated with a severe disease and a worse outcome. Therefore, targeting the hyper-inflammatory response might improve the clinical outcome of COVID-19.Eunyoung Emily LeeKyoung-Ho SongWoochang HwangSin Young HamHyeonju JeongJeong-Han KimHong Sang OhYu Min KangEun Bong LeeNam Joong KimBum Sik ChinJin Kyun ParkNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Eunyoung Emily Lee Kyoung-Ho Song Woochang Hwang Sin Young Ham Hyeonju Jeong Jeong-Han Kim Hong Sang Oh Yu Min Kang Eun Bong Lee Nam Joong Kim Bum Sik Chin Jin Kyun Park Pattern of inflammatory immune response determines the clinical course and outcome of COVID-19: unbiased clustering analysis
description	Abstract The objective of the study was to identify distinct patterns in inflammatory immune responses of COVID-19 patients and to investigate their association with clinical course and outcome. Data from hospitalized COVID-19 patients were retrieved from electronic medical record. Supervised k-means clustering of serial C-reactive protein levels (CRP), absolute neutrophil counts (ANC), and absolute lymphocyte counts (ALC) was used to assign immune responses to one of three groups. Then, relationships between patterns of inflammatory responses and clinical course and outcome of COVID-19 were assessed in a discovery and validation cohort. Unbiased clustering analysis grouped 105 patients of a discovery cohort into three distinct clusters. Cluster 1 (hyper-inflammatory immune response) was characterized by high CRP levels, high ANC, and low ALC, whereas Cluster 3 (hypo-inflammatory immune response) was associated with low CRP levels and normal ANC and ALC. Cluster 2 showed an intermediate pattern. All patients in Cluster 1 required oxygen support whilst 61% patients in Cluster 2 and no patient in Cluster 3 required supplementary oxygen. Two (13.3%) patients in Cluster 1 died, whereas no patient in Clusters 2 and 3 died. The results were confirmed in an independent validation cohort of 116 patients. We identified three different patterns of inflammatory immune response to COVID-19. Hyper-inflammatory immune responses with elevated CRP, neutrophilia, and lymphopenia are associated with a severe disease and a worse outcome. Therefore, targeting the hyper-inflammatory response might improve the clinical outcome of COVID-19.
format	article
author	Eunyoung Emily Lee Kyoung-Ho Song Woochang Hwang Sin Young Ham Hyeonju Jeong Jeong-Han Kim Hong Sang Oh Yu Min Kang Eun Bong Lee Nam Joong Kim Bum Sik Chin Jin Kyun Park
author_facet	Eunyoung Emily Lee Kyoung-Ho Song Woochang Hwang Sin Young Ham Hyeonju Jeong Jeong-Han Kim Hong Sang Oh Yu Min Kang Eun Bong Lee Nam Joong Kim Bum Sik Chin Jin Kyun Park
author_sort	Eunyoung Emily Lee
title	Pattern of inflammatory immune response determines the clinical course and outcome of COVID-19: unbiased clustering analysis
title_short	Pattern of inflammatory immune response determines the clinical course and outcome of COVID-19: unbiased clustering analysis
title_full	Pattern of inflammatory immune response determines the clinical course and outcome of COVID-19: unbiased clustering analysis
title_fullStr	Pattern of inflammatory immune response determines the clinical course and outcome of COVID-19: unbiased clustering analysis
title_full_unstemmed	Pattern of inflammatory immune response determines the clinical course and outcome of COVID-19: unbiased clustering analysis
title_sort	pattern of inflammatory immune response determines the clinical course and outcome of covid-19: unbiased clustering analysis
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/45194ea1576e47ceb5940ef1dd612e28
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Pattern of inflammatory immune response determines the clinical course and outcome of COVID-19: unbiased clustering analysis

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