Factors Affecting TNF-α Decrease in COVID-19 Patients

Year 2024, Volume: 14 Issue: 1, 46 - 53, 16.01.2024

Muhammet Gülhan Merve Alpay Şule Yıldız Nevra Ezgi Yaşlı Murat Acat Gözde Kahraman Peri Arbak

https://doi.org/10.33631/sabd.1240226

Abstract

Aim: Tumor necrosis factor-alpha (TNF-α) have several functions, including cell survival, differentiation, and proliferation. TNF-α may effect the cell death during the cytokine storm that occurred during COVID-19 infection. We aimed to investigate, the factors that affects the TNF-α decrease in COVID-19 patients.
Material and Methods: Totally 44 individuals with COVID-19 infection were included the study. Blood counts, biochemical examinations and D-dimer examinations were obtained. Comorbidities and initial symptoms of the patients were recorded. TNF-α, CRP and ferritin values were measured twice on the 1st and 7th days of hospitalization. The change in this values were examined according to comorbidities, initial symptoms and steroid usage.
Results: Of a total of 44 patients, 56.8% were male (25/44) and 43.2 % were female (19/44). TNF-α decrease was found to be statistically significant in non-diabetic patients, while TNF-α decrease was found to be insignificant in diabetic patients. CRP decrease was found to be statistically significant in both diabetic and non-diabetic patients while ferritin decrease was insignificant in both diabetic and non-diabetic patients. While TNF-α and CRP decreased statistically significantly in those without lung disease, it was observed that both TNF-α and CRP decreases were not significant in those with lung disease. The decrease in TNF-α and CRP was statistically insignificant in those who did not treated with steroids, while the decrease in TNF-α and CRP was significant in those who treated with steroids.
Conclusion: Steroids decreases the TNF-α levels. TNF decrease is not significant in those with diabetes and lung disease.

Keywords

Tumor necrosis factor-alpha, C-reactive protein, Diabetes mellitus, COVID-19

COVID-19 Hastalarında TNF-α Düşüşünü Etkileyen Faktörler

Abstract

Amaç: Tümör nekrozis faktör-alfa (TNF-α) hücrenin hayatta kalması, farklılaşması ve çoğalması da dahil çeşitli işlevlere sahiptir. TNF-α, COVID-19 enfeksiyonu sırasında ortaya çıkan sitokin fırtınası sırasında hücre ölümünü etkileyebilir. Bu çalışmada COVID-19 hastalarında TNF-α düşüşüne etki eden faktörleri araştırmak amaçlandı.
Gereç ve Yöntemler: Çalışmaya COVID-19 enfeksiyonu olan toplam 44 kişi dahil edildi. Kan sayımı, biyokimyasal incelemeler ve D-dimer incelemeleri yapıldı. Hastaların ek hastalıkları ve başlangıç semptomları kaydedildi. TNF-α, CRP ve ferritin değerleri yatışının 1. ve 7. günlerinde iki kez ölçüldü. Bu değerlerdeki değişim komorbiditelere, başlangıç semptomlarına ve steroid kullanımına göre incelendi.
Bulgular: Toplam 44 hastanın %56,8'i erkek (25/44) ve %43,2'si kadındı (19/44). TNF-α düşüşü diyabetik olmayan hastalarda istatistiksel olarak anlamlı bulunurken, diyabetik hastalarda TNF-α düşüşü anlamsız bulundu. CRP düşüşü hem diyabetik hem de diyabetik olmayan hastalarda istatistiksel olarak anlamlı bulunurken, ferritin düşüşü hem diyabetik hem de diyabetik olmayan hastalarda anlamsız bulundu. Akciğer hastalığı olmayanlarda TNF-α ve CRP istatistiksel olarak anlamlı düzeyde düşerken, akciğer hastalığı olanlarda hem TNF-α hem de CRP düşüşlerinin anlamlı olmadığı görüldü. TNF-α ve CRP'deki azalma steroid ile tedavi edilmeyenlerde anlamlı değilken, TNF-α ve CRP'deki azalma steroid tedavisi alanlarda istatistiksel olarak anlamlıydı.
Sonuç: Steroidler TNF-α düzeyini düşürürler. Akciğer hastalığı ve diyabeti olanlarda TNF-α düşüşü anlamlı değildir.

Keywords

Tümör nekrozis faktör-alfa, C-reaktif protein, Diyabetes Mellitus, COVID-19

References

• Jang DI, Lee AH, Shin HY, Song HR, Park JH, Kang TB, et al. The role of tumor necrosis factor alpha (TNF-α) in autoimmune disease and current tnf-α inhibitors in therapeutics. Int J Mol Sci. 2021; 22(5): 2719.
• Karki R, Sharma BR, Tuladhar S, Williams EP, Zalduondo L, Samir P, et al. Synergism of TNF-α and IFN-γ triggers inflammatory cell death, tissue damage, and mortality in SARS-CoV-2 infection and cytokine shock syndromes. Cell. 2021; 184(1): 149-168.e17.
• Pedersen SF, Ho YC. SARS-CoV-2: a storm is raging. J Clin Invest. 2020; 130(5): 2202-05.
• Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020; 46(5): 846-8.
• Chen G, Wu D, Guo W, Cao Y, Huang D, Wang H, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest. 2020; 130(5): 2620-9.
• Rizk JG, Kalantar-Zadeh K, Mehra MR, Lavie CJ, Rizk Y, Forthal DN. Pharmaco-immunomodulatory therapy in COVID-19. Drugs. 2020; 80(13): 1267-92.
• Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020; 8(5): 475-81.
• Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. China medical treatment expert group for Covid-19. Clinical characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020; 382(18): 1708-20.
• Zhang JJ, Dong X, Cao YY, Yuan YD, Yang YB, Yan YQ, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020; 75(7): 1730-41.
• Kumar A, Arora A, Sharma P, Anikhindi SA, Bansal N, Singla V, et al. Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis. Diabetes Metab Syndr. 2020; 14(4): 535-45.
• Maddaloni E, Buzzetti R. Covid-19 and diabetes mellitus: unveiling the interaction of two pandemics. Diabetes Metab Res Rev. 2020; 36(7): e33213321.
• Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. HLH Across Speciality Collaboration, UK. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020; 395(10229): 1033-34.
• Zhou Y, Chi J, Lv W, Wang Y. Obesity and diabetes as high-risk factors for severe coronavirus disease 2019 (Covid-19). Diabetes Metab Res Rev. 2021; 37(2): e3377.
• Yan Y, Yang Y, Wang F, Ren H, Zhang S, Shi X, et al. Clinical characteristics and outcomes of patients with severe covid-19 with diabetes. BMJ Open Diabetes Res Care. 2020; 8(1): e001343.
• Hameed I, Masoodi SR, Mir SA, Nabi M, Ghazanfar K, Ganai BA. Type 2 diabetes mellitus: From a metabolic disorder to an inflammatory condition. World J Diabetes. 2015; 6(4): 598-612.
• Mortaz E, Tabarsi P, Jamaati H, Dalil Roofchayee N, Dezfuli NK, Hashemian SM, et al. Increased serum levels of soluble TNF-α receptor is associated with ICU mortality in COVID-19 patients. Front Immunol. 2021; 12: 592727.
• Duret PM, Spielmann L, Messer L. Response to: 'Correspondence on recovery from COVID-19 in a patient with spondyloarthritis treated with TNF-alpha inhibitor etanercept. A report on a COVID-19 patient with psoriatic arthritis receiving ustekinumab' by Messina et al. Ann Rheum Dis. 2021; 80(5): e80.
• RECOVERY Collaborative Group. Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet. 2021; 397(10285): 1637-45.
• Feldmann M, Maini RN, Woody JN, Holgate ST, Winter G, Rowland M, et al. Trials of anti-tumour necrosis factor therapy for COVID-19 are urgently needed. Lancet. 2020; 395(10234): 1407-09.
• Soy M, Keser G, Atagündüz P, Tabak F, Atagündüz I, Kayhan S. Cytokine storm in COVID-19: pathogenesis and overview of anti-inflammatory agents used in treatment. Clin Rheumatol. 2020; 39(7): 2085-94.
• Baslılar S, Pehlivan O. Evaluation of factors affecting the frequency and clinical course of COVID-19 in patients using anti-TNF-alpha agents. Rev Assoc Med Bras (1992). 2021; 67(9): 1286-92.