ارتباط مستويات IL-6 و TNF alpha بالمعايير الدموية والمصلية في مرضى جائحة COVID-19 الخاضعين للعلاج

Association of IL-6 and TNF alpha levels With hematological and biochemical parameters in treated COVID-19 patients

Abstract

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
COVID-19 is characterized by a cytokine storm manifested by elevation in the levels of many inflammatory and biochemical markers and changes in the blood indices.
The aim of this study was assess the role of IL-6 and TNF-alpha levels with other hematological and biochemical parameters in disease status in COVID-19 patients who are on treatment.
For this purpose a total of 84 patients with COVID- 19- confirmed by SARS-COV-2 –specific RT-PCR of Nasopharyngeal (NP) swab specimen were enrolled in this study. The patients were attended to Al-Hussein Medical city hospitals for the period from 10-10-2020 to 29-12-2020.
Among them 54 (64.3%) were male and 30(35.7%) were female. The mean age was 56.08 years and the age range was between 25 to 85 years, these results indicate that older male patients are at more risk.
Total white blood cell counts was significantly increased in moderate and severe cases (p=0.000) compared to mild cases. Furthermore neutrophil percentages were significantly increased (p=0.000), whereas lymphocyte percentages were decreased (p=0.001) in moderate and severe patients in comparison to mild patients.
The most of the biochemical markers in this study, namely; D- dimer, serum ferritin, Lactate dehydrogenase, C-reactive protein, Alanine aminotransferase, Aspartate aminotransferase were shown to be positively correlated with severity of the COVID-19 symptoms (r=0.259, p=0.018; r=0.264, p=0.019; r=0.441, p=0.000; r=0.317, p=0.003; r=0.225, p=0.049; r=0.234, p=0.033, respectively).
The levels of both IL-6 and TNF-α were elevated in COVID-19 patients and this raise in the levels were higher in moderate and severe patients compared to mild patients (p=0.20, p=0.07, respectively).
Within the severe COVID-19 patients, IL-6 serum levels were negatively correlated with lymphocyte percentages (r=-0.36, p=0.06) and positively correlated with neutrophil percentages (r=0.482, p= 0.009). On the other hand, within the mild COVID-19 patients, TNF-α serum levels were negatively correlated with lymphocyte percentages (r=-0.44, p=0.03) and with hemoglobin percentages (r=-0.415, p=0.031).
IL-6 serum levels were positively correlated with serum ferritin (r=0.286, p=0.011) and negatively correlated with Aspartate aminotransferase (r=-0.224, p=0.05). However, TNF-α serum levels did not show significant correlation with the studied biochemical markers in the COVID-19 patients. Nevertheless, TNF-α was positively correlated with D. dimer within the severe COVID-19 patients (r=0.406, p=0.039).
In conclusion, all studied biomarkers and cytokines are elevated and there were hematological changes in COVID-19 patients, however, it cannot attribute all the changes in the biochemical and hematological parameters to the elevated levels of IL-6 and TNF-α. Therefore, this study recommend studying other proinflammatory cytokines.