Differential cytokine and chemokine signatures in bronchoalveolar lavage and plasma predict clinical outcomes of COVID-19 patients hospitalized in intensive care unit

This study explores the immune response dynamics in critically ill SARS-CoV-2 patients compared to non-SARS-CoV-2 controls both hospitalized in intensive care unit (ICU), focusing on localized and systemic inflammatory profiles to identify patterns linked to clinical outcomes. A cohort of ICU patients (37 SARS-CoV-2 positive, 17 controls) underwent bronchoalveolar lavage (BAL) and plasma analysis to assess inflammatory markers using a multiplex assay. SARS-CoV-2 patients showed distinct clinical and immunological features, including prolonged ICU stays and elevated markers of systemic inflammation. Cluster analysis revealed subgroup-specific immune signatures, with COVID-19 survivors demonstrating coordinated cytokine/chemokine interactions suggestive of adaptive immune regulation, while non-survivors exhibited dysregulated profiles indicative of maladaptive inflammation. The study underscores the spatial segregation of immune responses, with lung-specific inflammation in BAL contrasting with systemic profiles, highlighting the importance of tissue-targeted monitoring. These findings suggest that immune profiling could inform stratification for tailored immunomodulatory therapies, advancing precision approaches in critical care for severe SARS-CoV-2 infections.