THE ROLE OF PRO-INFLAMMATORY CYTOKINES IN CYTOKINE STORM AND ITS RELATION TO THE SEVERITY OF COVID-19 INFECTION

Abstract

The new coronavirus disease 2019 (COVID-19) outburs tbegan in December 2019 in Wuhan, China, and has occurred as a serious pandemic. SARS-CoV-2 infection is illustrious with numerous epidemiological and pathological characteristics, among them, being the excessive liberation of cytokine, which sequentially elicit an anomalous uninhibited reaction identified as a cytokine storm.   The aim of the present study to estimate the association among some proinflammatory cytokines(Interleukin 6, Tumor necrosis factor-alpha) and ferritin level in the sera of patients diagnosed with corona virus disease 2019 to find out its role in cytokine storm and its relation to the outcome of Corona virus disease 2019 regarding severity and mortality. This is a case-control study (comparative) carried out in Kirkuk general hospital (covid-19 epidemic center)/Kirkuk/Iraq from the period started from 1^st of November 2020 to the end of January 2021.  The study included 60 patients with positive rRT-PCR for Covid-19: 20 patients with severe symptoms and Spo2 less than 90% admitted into the Intensive care unit in the hospital, 20 patients with moderate symptoms with Spo2 90-94% admitted to the hospital, and 20 patients with mild symptoms with Spo2 >94%, treated as an outpatient. 30 adult subjects were considered as control with negative rRT-PCR for Covid-19. The blood samples were collected from patients and control groups, and interviews were carried out with them using a questionnaire form. IL-6 and TNF-α were measured by ELISA techniques, while ferritin measure was done by the i-chroma technique. The study showed that, the mean of age was higher in severe COVID19patientsgroup (64. 25) compared with moderate (63. 25) and mild (47. 55) groups although the result was non-significant.  the levels of spo2 decreased in the severe group < 90%, while in a moderate group between 90-94% and the mild group >94%.  IL-6, TNF α, and ferritin were measured in COVID19 patients, and compared with a healthy control group, a significant increase was observed in the level of the biomarkers (means 23. 81, 22. 07, 441. 69) in patients group in comparison with a control group (11. 26, 12. 68, 75. 62), p-value<0. 05.  IL-6,TNF α, and Ferritin showed a significant increase in severe COVID19 patientsgroup (means- 41. 52, 38. 15,642. 91) respectively, in comparison with the moderate patients' group (means- 16. 72,15. 35, 483. 26) and mild patients group (means -13. 21, 12. 7, 198. 91).

Conclusion: The current study shows an obvious relation between measured parameters (IL-6, TNFα, and ferritin) and the progression, severity of the disease. Since, they play an important role in cytokine storm syndrome, serial measurements of these parameters together can be used as predictors for worse prognosis, the severity, and fatality of COVID 19.