• Maxime Samson, Barbara Nicolas, Marion Ciudad, Hélène Greigert, Alexandre Guilhem, Claudie Cladiere, Cécile Straub, Mathieu Blot, Lionel Piroth, Thomas Rogier, Hervé Devilliers, Patrick Manckoundia, Thibault Ghesquiere, Stéphanie Francois, Daniela Lakomy, Sylvain Audia, and Bernard Bonnotte.
• Department of Internal Medicine and Clinical Immunology, University Hospital of Dijon; INSERM U1098, University of Bourgogne-Franche Comté, Dijon, France. Electronic address: maxime.samson@chu-dijon.fr.
• Eur. J. Intern. Med. 2022 Aug 1; 102: 104109104-109.

IntroductionThis study aimed to identify markers of disease worsening in patients hospitalized for SARS-Cov2 infection.Patients And MethodsPatients hospitalized for severe recent-onset (<1 week) SARS-Cov2 infection were prospectively included. The percentage of T-cell subsets and plasma IL-6 at admission (before any steroid therapy) were compared between patients who progressed to a critical infection and those who did not.ResultsThirty-seven patients (18 men, 19 women) were included; 11 (30%) progressed to critical infection. At admission, the critical infection patients were older (P = 0.021), had higher creatinine levels (P = 0.003), and decreased percentages of circulating B cells (P = 0.04), T cells (P = 0.009), and CD4+ T cells (P = 0.004) than those with a favorable course. Among T cell subsets, there was no significant difference between the two groups except for the percentage of Th17 cells, which was two-fold higher in patients who progressed to critical infection (P = 0.028). Plasma IL-6 at admission was also higher in this group (P = 0.018). In multivariate analysis, the percentage of circulating Th17 cells at admission was the only variable associated with higher risk of progression to critical SARS-Cov2 infection (P = 0.021).ConclusionThis study suggests that an elevated percentage of Th17 cells in patients hospitalized for SARS-Cov2 infection is associated with an increased risk of progression to critical disease. If these data are confirmed in a larger study, this marker could be used to better target the population of patients in whom tocilizumab could decrease the risk of progression to critical COVID-19.Copyright © 2022. Published by Elsevier B.V.

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