Dexamethasone provides benefits in patients with coronavirus disease 2019 (COVID-19), although data regarding immunological profiles and viral clearance are limited. This study aimed to evaluate for differences in biomarkers among patients with severe COVID-19 who did and did not receive dexamethasone. We measured plasma biomarkers of lung epithelial/endothelial injury and inflammation in 31 patients with severe COVID-19 and in 13 controls. Changes in biomarkers and clinical parameters were compared during the 7-day period among COVID-19 patients, and also according to dexamethasone use. Thirty-two patients with severe COVID-19 who received mechanical ventilation (n = 6), high-flow nasal cannula (n = 11), and supplemental oxygen (n = 15) were analyzed. Relative to controls, patients with severe COVID-19 had significantly higher concentrations of biomarkers related to glycocalyx shedding (endocan and syndecan-1), endothelial injury (von Willebrand factor), and inflammation (soluble receptor for advanced glycation end-products [sRAGE] and interleukin-6). The 7-day decreases in biomarkers of endothelial injury (angiopoietin-2 [Ang-2] and intercellular adhesion molecule-1 [ICAM-1]) and sRAGE, but not in the biomarker of lung epithelial injury (surfactant protein D), were correlated with decreases in C-reactive protein and radiologic score at day 7. Twenty patients (63%) received dexamethasone, and the dexamethasone and non-dexamethasone groups differed in terms of disease severity. However, dexamethasone was associated marginally with increased SpO 2 /FiO 2 and significantly with decreases in C-reactive protein and radiologic score after adjusting for baseline imbalances. Furthermore, the dexamethasone group exhibited a significant decrease in the concentrations of Ang-2, ICAM-1, soluble form of the Tie2 receptor (a biomarker of glycocalyx shedding), and sRAGE. Both groups exhibited a clinically insignificant increase in the cycle threshold value. Severe COVID-19 may be characterized by more severe endothelial injury and inflammation, and less severe lung epithelial injury. There is a possibility that dexamethasone improved severe COVID-19 and related endothelial injury without delaying viral clearance.
【초록키워드】 COVID-19, Dexamethasone, coronavirus disease, Inflammation, Coronavirus disease 2019, Biomarker, Biomarkers, severe COVID-19, mechanical ventilation, disease severity, interleukin-6, lung, C-reactive protein, oxygen, nasal, ICAM-1, viral clearance, angiopoietin, Protein, Viral, Patient, von Willebrand factor, endocan, endothelial injury, syndecan, receptor, group, change, COVID-19 patients, Clinical parameters, Concentration, High-flow nasal cannula, Cycle threshold value, Injury, nasal cannula, intercellular adhesion molecule, supplemental oxygen, both groups, immunological profile, decreases, relative, significant decrease, clinical parameter, controls, benefit, decrease, lung epithelial, plasma biomarker, analyzed, radiologic, evaluate, significantly, clinically, exhibited, characterized, provide, less, correlated, increase in, significantly higher, receive, baseline, intercellular, 【제목키워드】 pilot study, IMPROVE,