Effects of pro-inflammatory interleukin-6 and anti-inflammatory interleukin-10 cytokines in pregnant women diagnosed with coronavirus disease 2019

Yıl 2022, Cilt: 27 Sayı: 3, 268 - 274, 27.09.2022

Mehmet Rifat Göklü , Şeyhmus Tunç , Şerif Aksin , Cengiz Andan

https://doi.org/10.21673/anadoluklin.1129488

Öz

Aim: This study aims to investigate the relationship between serum interleukin (IL)-6 and IL-10 levels in coronavirus disease (COVID)-19 positive pregnant women and the course of the disease.

Methods: In our study, serum IL-6 and IL-10 levels were measured in 28 third-trimester COVID-19-positive pregnant women and 30 third-trimester healthy pregnant women. COVID-19-positive cases were classified as carriers or patients. While 13 of the pregnant women in the study group were asymptomatic or were being followed out due to mild illness; a total of 15 pregnant women, 7 of whom were in the intensive care unit (ICU), were hospitalized and treated. IL-6 and IL-10 tests of COVID-19-positive pregnant women were studied at the time of first application.

Results: Seven (25%) patients with COVID-19 required admission to an ICU. The IL-6 level was found to be significantly lower in COVID-19-negative pregnant women compared to pregnant women who were COVID-19 carriers and patients (p=0.01). The IL-10 level was found to be significantly higher in pregnant women who were negative for COVID-19 compared to pregnant women who were COVID-19 carriers (p=0.002) and patients (p=0.002).

Conclusion: Close monitoring of IL-6 and IL-10 cytokine levels is recommended to minimize the risk of adverse outcomes in pregnant women presenting with a suspected or confirmed diagnosis of COVID-19. In this way, it may be possible to distinguish moderate–mild COVID-19 from severe COVID-19 in pregnant women.

Anahtar Kelimeler

COVID-19, interleukin-6, interleukin-10, pregnancy

Koronavirüs hastalığı 2019 tanısı konmuş gebe kadınlarda proinflamatuar interlökin-6 ve anti-inflamatuar interlökin-10 sitokinlerinin etkileri

Öz

Amaç: Çalışmamızda Koronavirüs Hastalığı (COVID)-19 pozitif gebelerde serum interlökin (IL)-6 ve IL-10 düzeyleri ile hastalığın seyri arasındaki ilişkinin araştırılması amaçlandı.

Yöntemler: Çalışmamızda 28 üçüncü trimester COVID-19 pozitif gebe ve 30 üçüncü trimester sağlıklı gebede serum IL-6 ve IL-10 düzeyleri ölçüldü. COVID-19 pozitif vakalar, taşıyıcı veya hasta olarak sınıflandırıldı. Çalışma grubundaki gebelerden 13’ü asemptomatik iken veya hafif hastalık nedeniyle takip edilirken; 7’si yoğun bakım ünitesinde (YBÜ) olmak üzere toplam 15 hamile kadın hastaneye kaldırılarak tedavi altına alındı. COVID-19 pozitif gebe kadınların IL-6 ve IL-10 testleri ilk uygulama sırasında çalışıldı.

Bulgular: COVID-19’lu 7 (%25) hastanın yoğun bakım ünitesine kabul edilmesi gerekti. COVID-19 negatif gebelerde IL-6 düzeyi, COVID-19 taşıyıcısı ve hasta gebelere göre anlamlı derecede düşük bulundu (p=0,01). COVID-19 negatif olan gebelerde IL-10 düzeyi, COVID-19 taşıyıcısı olan gebelere (p=0,002) ve hastalara (p=0,002) göre anlamlı derecede yüksek bulundu.

Sonuç: Şüpheli veya doğrulanmış bir COVID-19 teşhisi ile başvuran hamile kadınlarda olumsuz sonuç riskini en aza indirmek için IL-6 ve IL-10 sitokin düzeylerinin yakından izlenmesi önerilir. Bu şekilde hamile kadınlarda orta-hafif COVID-19’u şiddetli COVID-19’dan ayırt etmek mümkün olabilir.

Anahtar Kelimeler

COVID-19, gebelik, interlökin-6, interlökin-10

Kaynakça

• Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
• Oğlak SC, Obut M. The risk of vicarious trauma among front-line and non-front-line midwives and nurses: Vicarious traumatization among medical staff. Aegean J Obstet Gynecol. 2020;2(2):1-4.
• Tunç Ş, Göklü MR. Koronavirüs Hastalığı 2019 (Covid-19) Pandemisi ile Karşı Karşıya Kalan Sağlık Çalışanları Arasında Tükenmişlik Sendromu. Harran Üniversitesi Tıp Fakültesi Dergisi. 2021;18(3):375-83.
• Tunç Ş, Göklü MR, Oğlak SC. COVID-19 in pregnant women: An evaluation of clinical symptoms and laboratory parameters based on the 3 trimesters. Saudi Med J. 2022;43(4):378-85.
• Oğlak SC, Obut M. Expression of ADAMTS13 and PCNA in the placentas of gestational diabetic mothers. Int J Morphol. 2021;39(1):38-44.
• Li X, Geng M, Peng Y, Meng L, Lu S. Molecular immune pathogenesis and diagnosis of COVID-19. J Pharm Anal. 2020;10(2):102-8.
• Nile SH, Nile A, Qiu J, Li L, Jia X, Kai G. COVID-19: Pathogenesis, cytokine storm and therapeutic potential of interferons. Cytokine Growth Factor Rev. 2020;53:66-70.
• Tunç Ş, Oğlak SC, Göklü MR, Gedik Özköse Z. Maternal mortality cases due to COVID-19 pandemic in a tertiary referral hospital. Perinat J. 2022;30(2):185-94.
• Bränn E, Edvinsson Å, Rostedt Punga A, Sundström-Poromaa I, Skalkidou A. Inflammatory and anti-inflammatory markers in plasma: from late pregnancy to early postpartum. Sci Rep. 2019;9(1):1863.
• Schumacher A, Brachwitz N, Sohr S, et al. Human chorionic gonadotropin attracts regulatory T cells into the fetal-maternal interface during early human pregnancy. J Immunol. 2009;182(9):5488-97.
• Mantovani A, Biswas SK, Galdiero MR, Sica A, Locati M. Macrophage plasticity and polarization in tissue repair and remodelling. J Pathol. 2013;229(2):176-85.
• Can E, Oğlak SC, Ölmez F, Bulut H. Serum neutrophil gelatinase-associated lipocalin concentrations are significantly associated with the severity of COVID-19 in pregnant patients. Saudi Med J. 2022;43(6):559-66.
• Kollias A, Kyriakoulis KG, Dimakakos E, Poulakou G, Stergiou GS, Syrigos K. Thromboembolic risk and anticoagulant therapy in COVID-19 patients: emerging evidence and call for action. Br J Haematol. 2020;189(5):846-7.
• Berhan Y. What immunological and hormonal protective factors lower the risk of COVID-19 related deaths in pregnant women? J Reprod Immunol. 2020;142:103180.
• Zaigham M, Andersson O. Maternal and perinatal outcomes with COVID-19: A systematic review of 108 pregnancies. Acta Obstet Gynecol Scand. 2020;99(7):823-9.
• Mullins E, Evans D, Viner RM, O’Brien P, Morris E. Coronavirus in pregnancy and delivery: rapid review. Ultrasound Obstet Gynecol. 2020;55(5):586-92.
• Ferrazzi E, Frigerio L, Savasi V, et al. Vaginal delivery in SARS-CoV-2-infected pregnant women in Northern Italy: a retrospective analysis. BJOG. 2020;127(9):1116-21.
• Can E, Oğlak SC, Ölmez F. Abnormal liver function tests in pregnant patients with COVID-19 - a retrospective cohort study in a tertiary center. Ginekol Pol. 2022;93(2):151-7.
• Samadi P, Alipour Z, Ghaedrahmati M, Ahangari R. The severity of COVID-19 among pregnant women and the risk of adverse maternal outcomes.Int J Gynaecol Obstet. 2021;154(1):92-9.
• Kim CNH, Hutcheon J, van Schalkwyk J, Marquette G. Maternal outcome of pregnant women admitted to intensive care units for coronavirus disease 2019. Am J Obstet Gynecol. 2020;223(5):773-4.
• Z Lu, R He, W Jiang, T Fan, Q Geng. Clinical characteristics and immune function analysis of COVID-19. Med J Wuhan Univ. 2020;41:529–32.
• Wan S, Yi Q, Fan S, Lv J, Zhang X, Guo L. Relationships among lymphocyte subsets, cytokines, and the pulmonary inflammation index in coronavirus (COVID-19) infected patients. Br J Haematol. 2020;189:428–37.
• Herold T, Jurinovic V, Arnreich C, et al. Elevated levels of IL-6 and CRP predict the need for mechanical ventilation in COVID-19. J Allergy Clin Immunol. 2020;146(1):128-36.e4.
• Huang Y, Tu M, Wang S, et al.Clinical characteristics of laboratory-confirmed positive cases of SARS-CoV-2 infection in Wuhan, China: A retrospective single-center analysis. Travel Med Infect Dis. 2020;36:101606.
• Behram M, Oğlak SC, Doğan Y. Evaluation of BRD4 levels in patients with early-onset preeclampsia. J Gynecol Obstet Hum Reprod. 2021;50(2):101963.
• Behram M, Oğlak SC, Dağ İ. Circulating levels of Elabela in pregnant women complicated with intrauterine growth restriction. J Gynecol Obstet Hum Reprod. 2021;50(8):102127.
• Behram M, Oğlak SC. The expression of angiogenic protein Cyr61 significantly increases in the urine of early-onset preeclampsia patients. J Contemp Med. 2021;11(5):605-9.
• Oğlak SC, Tunç Ş, Ölmez F. First Trimester Mean Platelet Volume, Neutrophil to Lymphocyte Ratio, and Platelet to Lymphocyte Ratio Values Are Useful Markers for Predicting Preeclampsia. Ochsner J. 2021;21(4):364-70.
• Behram M, Oğlak SC, Başkıran Y, et al. Maternal serum IL-22 concentrations are significantly upregulated in patients with preterm premature rupture of membranes. Ginekol Pol. 2021;92(9):631-6.
• Ölmez F, Oğlak SC, Gedik Özköse Z. Increased maternal serum aquaporin-9 expression in pregnancies complicated with early-onset preeclampsia. J Obstet Gynaecol Res. 2022;48(3):647-53.
• Graham C, Chooniedass R, Stefura WP, et al.In vivo immune signatures of healthy human pregnancy: Inherently inflammatory or anti-inflammatory? PLoS One. 2017;12(6).
• Qiu X, Zhang L, Tong Y, Qu Y, Wang H, Mu D. Interleukin-6 for early diagnosis of neonatal sepsis with premature rupture of the membranes: A meta-analysis. Medicine (Baltimore). 2018;97(47):e13146.
• Tanacan A, Yazihan N, Erol SA, Anuk AT, Yucel Yetiskin FD, Biriken D, et al. The impact of COVID-19 infection on the cytokine profile of pregnant women: A prospective case-control study. Cytokine. 2021;140:155431.
• Sherer ML, Lei J, Creisher P, et al. Dysregulated immunity in SARS-CoV-2 infected pregnant women. Preprint. medRxiv. 2020;2020.11.13.20231373.
• Zhao Y, Qin L, Zhang P, et al. Longitudinal COVID-19 profiling associates IL-1RA and IL-10 with disease severity and RANTES with mild disease. JCI Insight. 2020;5(13):e139834.
• Gibson PG, Qin L, Puah SH. COVID-19 acute respiratory distress syndrome (ARDS): clinical features and differences from typical pre-COVID-19 ARDS. Med J Aust. 2020;213(2):54-6.