Objectives: The longitudinal characterization and risk of poor outcomes related to cytokine overproduction in critical coronavirus disease 2019 (COVID-19) patients with hyperinflammation in bronchoalveolar lavage requires further investigation. Methods: We enrolled two critically ill patients with comorbidities diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detected by RT-PCR during hospitalization. Clinical characteristics, longitudinal immunological, and biochemical parameters of each critical COVID-19 case were collected. Main Results: The clinical characteristics and laboratory results of each case demonstrated critical symptoms of COVID-19 with poor outcomes. Both nasopharyngeal swabs and bronchoalveolar lavage fluid (BALF) samples tested positive for SARS-CoV-2. Two patients received targeted treatments against pathogen infection and inflammation in addition to interventional therapies, except for Patient 2, who received an additional artificial liver system treatment. Hyperinflammation with a dominantly high level of IL-6 was observed in BALF samples from both critical cases with decreased T cell populations. High levels of cytokines and pathological parameters were successively maintained in Patient 1, but rapidly reduced at the late treatment stage in Patient 2. The outcome of Patient 1 is death, whereas the outcome of Patient 2 is recovery. Conclusions: This case report suggests that a high risk of poor outcomes was related to a heavily hyperinflammatory milieu in both the blood and lungs of critical COVID-19 patients. The artificial liver intervention on cytokines overproduction might be beneficial for the recovery of critical COVID-19 patients as a reliable therapy that can be coordinated with targeted treatments, which ought to be further tested in adequately designed and powered clinical trials.
【저자키워드】 COVID-19, SARS-CoV-2, Bronchoalveolar lavage fluid, hyperinflammation, poor outcomes, cytokine overproduction, 【초록키워드】 Treatment, coronavirus disease, Inflammation, coronavirus, therapy, Hospitalization, Clinical characteristics, IL-6, Infection, lung, clinical trials, Comorbidity, risk, Intervention, cytokine, outcome, RT-PCR, Case report, outcomes, Nasopharyngeal swab, T cell, Characteristics, pathogen, clinical, Patient, death, BALF, Critical, liver, Blood, Therapies, Bronchoalveolar lavage, high risk, Critically ill patient, acute respiratory syndrome, Critical case, COVID-19 case, symptoms of COVID-19, critical COVID-19 patients, positive, parameter, Hyperinflammatory, populations, immunological, enrolled, tested, collected, addition, diagnosed, reduced, Two patient, demonstrated, biochemical parameter, critical COVID-19 patient, laboratory result, was related, 【제목키워드】 longitudinal, characterization, report, lavage, Ill,