scholarly journals IL1RNCoding Variant Is Associated with Lower Risk of Acute Respiratory Distress Syndrome and Increased Plasma IL-1 Receptor Antagonist

2013 ◽  
Vol 187 (9) ◽  
pp. 950-959 ◽  
Author(s):  
Nuala J. Meyer ◽  
Rui Feng ◽  
Mingyao Li ◽  
Yang Zhao ◽  
Chau-Chyun Sheu ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Receptor Antagonist ◽  
Lower Risk ◽  
Distress Syndrome

scholarly journals Immunosuppression is associated with a lower risk of moderate to severe acute respiratory distress syndrome in COVID-19.

2020 ◽  
Author(s):  
Enric Monreal ◽  
Susana Sainz de la Maza ◽  
Pedro Gullón ◽  
Elena Natera-Villalba ◽  
Juan Luis Chico-García ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Lower Risk ◽  
Distress Syndrome ◽  
Drug Discontinuation ◽  
Risk Of Death ◽  
Non Invasive Ventilation ◽  
Secondary Endpoints ◽  
Male Patients

Abstract BACKGROUND: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that has spread rapidly worldwide. The role of immunosuppression among COVID-19 patients has not been elucidated and management may be challenging.OBJECTIVE: To assess differences in severe outcomes of hospitalized patients with COVID-19 according to immune system state.DESIGN: Retrospective single-center observational study with confirmed COVID-19 patients admitted to Hospital Universitario Ramón y Cajal from March 18, 2020 to April 04, 2020. The final date of follow-up was April 09, 2020.PARTICIPANTS: Confirmed COVID-19 patients.MAIN MEASURES: The primary endpoint was development of moderate-severe acute respiratory distress syndrome (ARDS). Time to moderate-severe ARDS, the need for mechanical or non-invasive ventilation (MV/NIV), death, and a composite of death or MV/NIV were secondary endpoints.KEY RESULTS: Of 138 patients included, 29 (21%) were immunocompromised (IC), with 95 (68.8%) male patients and a median (IQR) age of 68 (54 – 78) years. Among the baseline characteristics, no relevant or significant differences were observed between IC and non-immunocompromised (non-IC) patients. A significantly lower proportion of IC patients (24.1% [95% CI, 11.4 – 44.0%]) compared to non-IC patients (49.5% [95% CI, 40.1 – 59.0%]) developed moderate-severe ARDS, in both unadjusted (OR 0.32 [95% CI, 0.13 – 0.82], p=0.018) and adjusted (aOR 0.16 [95% CI, 0.05 – 0.52], p=0.003) analyses. A positive non-significant trend toward a longer time to moderate or severe ARDS, a lower need for MV/NIV, and a lower risk of death or MV/NIV were detected in IC. A trend toward a shorter- hospitalization in IC was observed.CONCLUSIONS: In our cohort of COVID-19 patients, immunosuppression was associated with a lower risk of moderate-severe ARDS. This suggests a potential protective effect from a hypothesized host hyper-inflammatory response and warrants reconsideration of drug discontinuation in IC patients.

scholarly journals Non-severe immunosuppression might be associated with a lower risk of moderate-severe acute respiratory distress syndrome in COVID-19.

2020 ◽  
Author(s):  
Enric Monreal ◽  
Susana Sainz de la Maza ◽  
Pedro Gullón ◽  
Elena Natera-Villalba ◽  
Juan Luis Chico-García ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Lower Risk ◽  
Distress Syndrome ◽  
Severe Immunosuppression ◽  
Risk Of Death ◽  
Non Invasive Ventilation ◽  
Secondary Endpoints ◽  
Male Patients

Abstract BACKGROUND: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that has spread rapidly worldwide. The role of immunosuppression among COVID-19 patients has not been elucidated and management may be challenging. OBJECTIVE: To assess differences in severe outcomes of hospitalized patients with COVID-19 according to immune system state. DESIGN: Retrospective single-center observational study with confirmed COVID-19 patients admitted to Hospital Universitario Ramón y Cajal from March 18, 2020 to April 04, 2020. The final date of follow-up was April 09, 2020.PARTICIPANTS: Confirmed COVID-19 patients. MAIN MEASURES: The primary endpoint was development of moderate-severe acute respiratory distress syndrome (ARDS). Time to moderate-severe ARDS, the need for mechanical or non-invasive ventilation (MV/NIV), death, and a composite of death or MV/NIV were secondary endpoints. KEY RESULTS: Of 138 patients included, 27 (19.6%) were immunosuppressed (IS), with 95 (68.8%) male patients and a median (Q1, Q3) age of 68 (54–78) years. Among the baseline characteristics, no relevant or significant differences were observed between IS and non-immunosuppressed (non-IS) patients, detecting a non-severe immunosupression among IS. A significantly lower proportion of IS patients (22.2% [95%CI, 9.8–43.0%]) compared to non-IS patients (49.5% [95%CI, 40.2–58.9%]) developed moderate-severe ARDS, in both unadjusted (OR 0.29 [95%CI, 0.11–0.76], p=0.014) and adjusted (aOR 0.16 [95%CI, 0.05–0.55], p=0.004) analyses. After stratifying by pathologies, only IS autoimmune diseases remained significant (aOR 0.12 [95%CI, 0.03–0.57], p=0.007). Non-significant trends toward a longer time to moderate or severe ARDS, a lower need for MV/NIV, and a lower risk of death or MV/NIV were detected in IS. CONCLUSIONS: In our cohort of COVID-19 patients, non-severe immunosuppression was associated with a lower risk of moderate-severe ARDS, especially among AD. This suggests a potential protective effect from a hypothesized host hyper-inflammatory response and warrants reconsideration of management of IS patients.

Acute Respiratory Distress Syndrome in a Carrier of an Interleukin-36 Receptor Antagonist Mutation With Generalized Pustular Psoriasis

2021 ◽  
pp. 247553032110517
Author(s):  
Avital Baniel ◽  
Efrat Bar-Ilan ◽  
Yuval Hilerowicz ◽  
Ilan Merdler ◽  
Eden Shkury ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Receptor Antagonist ◽  
Distress Syndrome ◽  
Novel Mutation ◽  
Rare Complication ◽  
Pustular Psoriasis ◽  
Generalized Pustular Psoriasis ◽  
Life Threatening

Background Generalized pustular psoriasis of von Zumbusch is a rare variant of psoriasis often accompanied by systemic, sometimes life-threatening, symptoms. Generalized pustular psoriasis sometimes arises in pregnancy. Case report A 31-year-old female, with a history of schizophrenia and recurrent episodes of gestation-associated pustular psoriasis, was admitted to our department because of a generalized pustular rash during the 22nd week of her fifth pregnancy. Clinical and histopathological examinations were suggestive of generalized pustular psoriasis (von Zumbusch type). During this hospitalization, she developed acute dyspnea, fever, tachycardia, and marked leukocytosis. An extensive workup failed to reveal an infectious, cardiac, or pulmonary abnormality, while severe respiratory distress necessitated mechanical ventilation. Radio-imaging revealed diffuse alveolar infiltrates consistent with acute respiratory distress syndrome (ARDS). In the absence of any other plausible cause, ARDS was considered as secondary to her skin disease. Genetic base was suspected, and genetic analysis uncovered a novel mutation in IL36RN encoding the IL-36 receptor antagonist. Only 15 cases of ARDS secondary to psoriasis have been described to date. This is the first report of this very rare complication in a known carrier of an IL36RN mutation. The fact that IL36RN is abundantly expressed in the lung as well as in the epidermis may underlie the unusual clinical features of this dramatic case. Conclusion The present case suggests the need to carefully monitor patients with pregnancy-associated generalized pustular psoriasis for possible life-threatening pulmonary complications and the possible link to IL36RN mutation.

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