case_images: PMC8452914_01
case_images: The longitudinal immunological parameters of each critical case with COVID-19. (A) Timeline of two critical cases with COVID-19 in hospital after onset of illness. The recorded events of all patients undergoing laboratory tests were marked with different diagrams on the indicated date. BALF, bronchoalveolar lavage fluid. (B) The levels of six cytokines in BALF from two critical patients on 29- and 39- days post onsets of Patient 1 and Patient 2, respectively. (C,D) The longitudinal immunological and biochemical parameters of each case. (C) The levels of six cytokines in serum from patients, normal range (pg/mL): IL-2 (<11.4), IL-4 (<12.9), IL-6 (<20), IL-10 (<5.9), TNF-alpha (<5.5), and IFN-gamma (<18). (D) The levels of IL-6 in whole blood from Patient 2. The case received an artificial liver system treatment (indicated by arrow in red) six times at 20, 21, 23, 26, 27, and 31 days post-onset and the corticosteroids therapy (indicated by arrow in blue) at 20, 36, 37, and 51 days post-onset, respectively.
case_images: fmed-08-690523-g0001.jpg
case_images: PMC8452914_01_fmed-08-690523-g0001.jpg
case_images: F1
case_images: During the hospitalization period, both patients underwent laboratory tests with detailed information in the timeline (Figure 1A). Notably, increased secretion of the anti-inflammatory cytokine IL-10 was also observed (Figure 1B). Patient 1. In the serum from Patient 2, these two cytokine levels dropped transiently due to the targeted treatment and remained high in the early stage; however, these sharply declined later on (after 57 days post-onset) (Figure 1C). Particularly, the levels of IL-6 in whole blood from Patient 2 transiently decreased during artificial liver treatment (21 to 31 days post-onset) and sharply declined after 37 days post-onset, indicating the beneficial effect from artificial liver treatment (Figure 1D).
case_images: The longitudinal biochemical parameters of each critical case with COVID-19. (A) The number and ratio of T cell populations in whole blood from patients, normal range (count, 106/L; ratio, %): CD16+CD56+ (84-724; 5-26), CD19+ (80-616; 5-22), CD3+ (723-2,737; 56-86), CD4+ (404-1,612; 33-58), and CD8+ (220-1129; 13-39). (B) The levels of NT-proBNP (N terminal pro B type natriuretic peptide) in plasma or PCT (Procalcitonin) in serum from patients, normal range (ng/mL): NT-proBNP (0-0.9); PCT (<0.1). (C) The levels of LDH (Lactate dehydrogenase) in serum or hsCRP (high-sensitivity C-reactive protein) in whole blood from patients, normal range: LDH (120-250 U/L); hsCRP (0-3 mg/L).
case_images: fmed-08-690523-g0002.jpg
case_images: PMC8452914_01_fmed-08-690523-g0002.jpg
case_images: F2
case_images: However, these were obviously restored later (after 30- and 57-days post-onset in Patients 1 and 2, respectively) (Figure 2A). Correspondingly, we observed a successively increased level of PCT (procalcitonin) in Patient 1; however, Patient 2's PCT levels were high in the early stage but sharply declined later (57 days post-onset) (Figure 2B), suggesting a good prognosis from MOF in Patient 2 but not in Patient 1. We also noticed a decreased level of N-terminal pro-B-type natriuretic peptide levels in both cases (Figure 2B), indicating a certain relief from acute cardiovascular failure. Meanwhile, these high factor levels rapidly reduced at the late treatment stage in Patient 2 (after 67 days post-onset) (Figure 2C), indicating the deterioration of Patient 1 and improvement of Patient 2 in terms of their COVID-19 progression.