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ORIGINAL RESEARCH article
Front. Immunol.
Sec. Inflammation
Volume 15 - 2024 |
doi: 10.3389/fimmu.2024.1485009
This article is part of the Research Topic The Role of Inflammation in Organ Injury View all 9 articles
Plasma IL-17A is increased in patients with critical MIS-C and associated to in-hospital mortality
Provisionally accepted
Emmerson CF de Farias
1,2*
Luciana MPP do Nascimento
2*
Manoel JC Pavão Junior
2*
Dalila C de A Pavão
2*
Ana PS Pinheiro
2*
Andreza HO Pinheiro
2*
Marias CB Alves
2*
Kissila MMM Ferraro
2*
Larisse FQ Aires
2
Luana G Dias
2*
Mayara MM Machado
2*
Michaelle JD Serrão
2*
Raphaellla R Gomes
2*
Sara MP de Moraes
2*
Gabriela CL Pontes
2*
Railana DPF Carvalho
2*
Cristiane TC Silva
2*
Carla MA das Neves
2*
Joyce CL dos Santos
2*
Adriana MB de Sousa
2*
Leda L da Silva
2*
Mary LFMF de Mello
2*
Patricia B Carvalho
3*
Renata de B Braga
3*
Kathia de O Harada
3*
Maria CA Justino
4*
Igor Brasil-Costa
5
Iran B Costa
5*
Marta Chagas Monteiro
6
Gleice Clemente
7
Maria Teresa Terreri
7- 1 Fundação Santa Casa do Pará, Belém, Brazil
- 2 Department of Pediatric Critical Care, Fundação Santa Casa de Misericórdia do Pará, Belém, Brazil
- 3 Departament of Pediatric Critical Care, Fundação Hospital das Clínicas Gaspar Viana, Belém, Brazil
- 4 Clinical Research Unit, Health Surveillance Secretariat, Brazilian Ministry of Health, Instituto Evandro Chagas, Ananindeua, Brazil
- 5 Immunology Laboratory, Virology Unit, Instituto Evandro Chagas, Belém, Brazil
- 6 Pharmaceutical Science Post-Graduation Program and Neuroscience and Cell Biology Graduate Program, Health Science Institute, Universidade Federal do Pará, Belém, Brazil
- 7 Division of Pediatric Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil
Background: Multisystem inflammatory syndrome in children (MIS-C) is a rare and severe post-COVID-19 complication with multiple phenotypes. Objectives: The aim of this study is to study inflammatory biomarkers (cytokines and oxidative stress) in critical MIS-C patients and to observe if there is association between these biomarkers and mortality. Methods: A single-center prospective study enrolled patients with MIS-C (with positive molecular test), aged between 1 month and 18 years of age. Data was collected from 20 pediatric intensive care unit (PICU)’s bed. Inflammatory biomarkers (cytokines and oxidative stress markers) were performed on day 1 and 3 after hospitalization. Survival rate was calculated, and Kaplan-Meier curves were plotted. Univariate and multivariate Cox regression analyses were conducted. The ROC (Receiver Operating Characteristic) curve analysis was performed. Results and conclusions: A total of 41 patients out of 109 patients admitted at PICU with suspected MIS-C during the study period were included, of which 33 (80.5%) were male, 9 (22%) were under one year old, and 30 (73.2%) presented comorbidities. Among them, 16 (39%) did not survive. The mean survival time was shorter in patients with higher levels of IL-17A (≥ 19.71 pg/mL) on day 1 (115 vs 323 days, p = 0.004). Higher levels of IL-17A on day 1 were associated with mortality in both the crude model (HR 1.03, CI95% 1.004-1.057, p = 0.022) and the adjusted model (HR 1.043, CI95% 1.013-1.075, p = 0.012). ROC analysis revealed a cut-off value for the IL-17A of 14.32 pg/ml. The other immunological and inflammatory markers did not demonstrate an association with survival (p>0.05). Our findings suggest that patients with high levels of IL-17A are at greater risk for death.
Keywords: COVID-19, Cytokines, Mortality, Oxidative Stress, pediatric intensive care unit, post-acute COVID-19 syndrome
Received: 23 Aug 2024; Accepted: 23 Dec 2024.
Copyright: © 2024 Farias, Nascimento, Pavão Junior, Pavão, Pinheiro, Pinheiro, Alves, Ferraro, Aires, Dias, Machado, Serrão, Gomes, Moraes, Pontes, Carvalho, Silva, Neves, Santos, Sousa, Silva, Mello, Carvalho, Braga, Harada, Justino, Brasil-Costa, Costa, Monteiro, Clemente and Terreri. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Emmerson CF de Farias, Fundação Santa Casa do Pará, Belém, Brazil
Luciana MPP do Nascimento, Department of Pediatric Critical Care, Fundação Santa Casa de Misericórdia do Pará, Belém, Brazil
Manoel JC Pavão Junior, Department of Pediatric Critical Care, Fundação Santa Casa de Misericórdia do Pará, Belém, Brazil
Dalila C de A Pavão, Department of Pediatric Critical Care, Fundação Santa Casa de Misericórdia do Pará, Belém, Brazil
Ana PS Pinheiro, Department of Pediatric Critical Care, Fundação Santa Casa de Misericórdia do Pará, Belém, Brazil
Andreza HO Pinheiro, Department of Pediatric Critical Care, Fundação Santa Casa de Misericórdia do Pará, Belém, Brazil
Marias CB Alves, Department of Pediatric Critical Care, Fundação Santa Casa de Misericórdia do Pará, Belém, Brazil
Kissila MMM Ferraro, Department of Pediatric Critical Care, Fundação Santa Casa de Misericórdia do Pará, Belém, Brazil
Luana G Dias, Department of Pediatric Critical Care, Fundação Santa Casa de Misericórdia do Pará, Belém, Brazil
Mayara MM Machado, Department of Pediatric Critical Care, Fundação Santa Casa de Misericórdia do Pará, Belém, Brazil
Michaelle JD Serrão, Department of Pediatric Critical Care, Fundação Santa Casa de Misericórdia do Pará, Belém, Brazil
Raphaellla R Gomes, Department of Pediatric Critical Care, Fundação Santa Casa de Misericórdia do Pará, Belém, Brazil
Sara MP de Moraes, Department of Pediatric Critical Care, Fundação Santa Casa de Misericórdia do Pará, Belém, Brazil
Gabriela CL Pontes, Department of Pediatric Critical Care, Fundação Santa Casa de Misericórdia do Pará, Belém, Brazil
Railana DPF Carvalho, Department of Pediatric Critical Care, Fundação Santa Casa de Misericórdia do Pará, Belém, Brazil
Cristiane TC Silva, Department of Pediatric Critical Care, Fundação Santa Casa de Misericórdia do Pará, Belém, Brazil
Carla MA das Neves, Department of Pediatric Critical Care, Fundação Santa Casa de Misericórdia do Pará, Belém, Brazil
Joyce CL dos Santos, Department of Pediatric Critical Care, Fundação Santa Casa de Misericórdia do Pará, Belém, Brazil
Adriana MB de Sousa, Department of Pediatric Critical Care, Fundação Santa Casa de Misericórdia do Pará, Belém, Brazil
Leda L da Silva, Department of Pediatric Critical Care, Fundação Santa Casa de Misericórdia do Pará, Belém, Brazil
Mary LFMF de Mello, Department of Pediatric Critical Care, Fundação Santa Casa de Misericórdia do Pará, Belém, Brazil
Patricia B Carvalho, Departament of Pediatric Critical Care, Fundação Hospital das Clínicas Gaspar Viana, Belém, Brazil
Renata de B Braga, Departament of Pediatric Critical Care, Fundação Hospital das Clínicas Gaspar Viana, Belém, Brazil
Kathia de O Harada, Departament of Pediatric Critical Care, Fundação Hospital das Clínicas Gaspar Viana, Belém, Brazil
Maria CA Justino, Clinical Research Unit, Health Surveillance Secretariat, Brazilian Ministry of Health, Instituto Evandro Chagas, Ananindeua, Brazil
Iran B Costa, Immunology Laboratory, Virology Unit, Instituto Evandro Chagas, Belém, Brazil
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