Collaborators: Baillie JK, Semple MG, Openshaw PJ, Alex B, Bach B, Barclay WS, Bogaert D, Chand M, Cooke GS, Docherty AB, Dunning J, da Silva Filipe A, Fletcher T, Green CA, Gupta RK, Harrison EM, Hiscox JA, Ho AYW, Horby PW, Ijaz S, Khoo S, Klenerman P, Law A, Lim WS, Mentzer AJ, Merson L, Meynert AM, Noursadeghi M, Moore SC, Palmarini M, Palmieri C, Paxton WA, Pollakis G, Price N, Rambaut A, Robertson DL, Russell CD, Sancho-Shimizu V, Scott JT, de Silva T, Sigfrid L, Solomon T, Sriskandan S, Stuart D, Summers C, Tedder RS, Thomson EC, Aa RT, Thwaites RS, Turtle L, Zambon M, Hardwick H, Donohue C, Lyons R, Griffiths F, Oosthuyzen W, Norman L, Pius R, Drake TM, Fairfield CJ, Knight S, Mclean KA, Murphy D, Shaw CA, Dalton J, Girvan M, Saviciute E, Roberts S, Harrison J, Marsh L, Connor M, Halpin S, Jackson C, Gamble C, Leeming G, Law A, Wham M, Clohisey S, Hendry R, Scott-Brown J, Greenhalf W, Shaw V, McDonald S, Keating S, Ahmed KA, Armstrong JA, Ashworth M, Asiimwe IG, Bakshi S, Barlow SL, Booth L, Brennan B, Bullock K, Carlucci N, Cass E, Catterall BW, Clark JJ, Clarke EA, Cole S, Cooper L, Cox H, Davis C, Dincarslan O, Carracedo AD, Dunn C, Dyer P, Elliott A, Evans A, Finch L, Fisher LW, Flaherty L, Foster T, Garcia-Dorival I, Greenhalf W, Gunning P, Hartley C, Holmes A, Jensen RL, Jones CB, Jones TR, Khandaker S, King K, Kiy RT, Koukorava C, Lake A, Lant S, Latawiec D, Lavelle-Langham L, Lefteri D, Lett L, Livoti LA, MacLean A, Massey H, Maziere N, Mancini M, McCafferty S, McDonald S, McEvoy L, McLauchlan J, Metelmann S, Miah NS, Middleton J, Mitchell J, Moore SC, Morrice K, Murphy EG, Murphy L, Penrice-Randal R, Pilgrim J, Prince T, Reynolds W, Ridley PM, Sales D, Shaw VE, Shears RK, Small B, Subramaniam KS, Szemiel A, Taggart A, Tanianis-Hughes J, Thomas J, Trochu E, van Tonder L, Wilcock E, Wrobel N, Zhang JE, Adeniji K, Agranoff D, Agwuh K, Ail D, Aldera EL, Alegria A, Angus B, Ashish A, Atkinson D, Bari S, Barlow G, Barnass S, Barrett N, Bassford C, Basude S, Baxter D, Beadsworth M, Bernatoniene J, Berridge J, Best N, Bothma P, Brealey D, Brittain-Long R, Bulteel N, Burden T, Burtenshaw A, Caruth V, Chadwick D, Chambler D, Chee N, Child J, Chukkambotla S, Clark T, Cole S, Collini P, Cosgrove C, Cupitt J, Cutino-Moguel MT, Dark P, Dawson C, Dervisevic S, Donnison P, Douthwaite S, DuRand I, Dushianthan A, Dyer T, Evans C, Eziefula C, Fegan C, Finn A, Fullerton D, Garg S, Garg S, Garg A, Gkrania-Klotsas E, Godden J, Goldsmith A, Graham C, Hardy E, Hartshorn S, Harvey D, Havalda P, Hawcutt DB, Hobrok M, Hodgson L, Holme A, Hormis A, Jacobs M, Jain S, Jennings P, Kaliappan A, Kasipandian V, Kegg S, Kelsey M, Kendall J, Kerrison C, Kerslake I, Koch O, Koduri G, Koshy G, Laha S, Laird S, Larkin S, Leiner T, Lillie P, Limb J, Linnett V, Little J, Lyttle M, MacMahon M, MacNaughton E, Mankregod R, Masson H, Matovu E, McCullough K, McEwen R, Meda M, Mills G, Minton J, Mirfenderesky M, Mohandas K, Mok Q, Moon J, Moore E, Morgan P, Morris C, Mortimore K, Moses S, Mpenge M, Mulla R, Murphy M, Nagel M, Nagarajan T, Nelson M, O'Shea MK, Otahal I, Ostermann M, Pais M, Papineni P, Panchatsharam S, Papakonstantinou D, Paraiso H, Patel B, Pattinson N, Pepperell J, Peters M, Phull M, Pintus S, Pooni JS, Post F, Price D, Prout R, Rae N, Reschreiter H, Reynolds T, Richardson N, Roberts M, Roberts D, Rose A, Rousseau G, Ryan B, Saluja T, Shah A, Shanmuga P, Sharma A, Shawcross A, Sizer J, Shankar-Hari M, Smith R, Snelson C, Spittle N, Staines N, Stambach T, Stewart R, Subudhi P, Szakmany T, Tatham K, Thomas J, Thompson C, Thompson R, Tridente A, Tupper-Carey D, Twagira M, Ustianowski A, Vallotton N, Vincent-Smith L, Visuvanathan S, Vuylsteke A, Waddy S, Wake R, Walden A, Welters I, Whitehouse T, Whittaker P, Whittington A, Wijesinghe M, Williams M, Wilson L, Wilson S, Winchester S, Wiselka M, Wolverson A, Wooton DG, Workman A, Yates B, Young P. Author information:
(1)National Heart and Lung Institute, Imperial College London, U.K.
(2)University of Edinburgh Centre for Inflammation Research, Edinburgh, U.K.
(3)Dept of Clinical Infection, Microbiology and Immunology, University of
(4)Centre for Medical Informatics, Usher Institute, University of Edinburgh,
(5)Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and
Molecular Medicine, University of Edinburgh, Edinburgh, U.K.
(6)Department of Infectious Disease, Faculty of Medicine, Imperial College
(7)Intensive Care Unit, Royal Infirmary Edinburgh, Edinburgh, U.K.
(8)Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, U.K.
(9)Tropical and infectious disease unit, Liverpool University Hospitals NHS
Foundation Trust (member of Liverpool Health Partners), U.K.
(10)National Infection Service, Public Health England, London, UK.
(11)NIHR Health Protection Research Unit in Emerging and Zoonotic Infections,
Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health
and Life Sciences, University of Liverpool, Liverpool, U.K.
[Email] [Email] [Email]
(12)Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, U.K.
(13)Intensive Care Unit, Royal Infirmary Edinburgh, Edinburgh, U.K.
[Email] [Email] [Email]
(14)Roslin Institute, University of Edinburgh, Edinburgh, U.K.
(15)National Heart and Lung Institute, Imperial College London, U.K.
[Email] [Email] [Email]
While it is now widely accepted that host inflammatory responses contribute to lung injury, the pathways that drive severity and distinguish coronavirus disease 2019 (COVID-19) from other viral lung diseases remain poorly characterized. We analyzed plasma samples from 471 hospitalized patients recruited through the prospective multicenter ISARIC4C study and 39 outpatients with mild disease, enabling extensive characterization of responses across a full spectrum of COVID-19 severity. Progressive elevation of levels of numerous inflammatory cytokines and chemokines (including IL-6, CXCL10, and GM-CSF) were associated with severity and accompanied by elevated markers of endothelial injury and thrombosis. Principal component and network analyses demonstrated central roles for IL-6 and GM-CSF in COVID-19 pathogenesis. Comparing these profiles to archived samples from patients with fatal influenza, IL-6 was equally elevated in both conditions whereas GM-CSF was prominent only in COVID-19. These findings further identify the key inflammatory, thrombotic, and vascular factors that characterize and distinguish severe and fatal COVID-19.
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