Biomarkers of Cytokine Release Syndrome Predict Disease Severity and Mortality From COVID-19 in Kidney Transplant Recipients.

Benotmane, Ilies; Perrin, Peggy; Gautier Vargas, Gabriela; Bassand, Xavier; Keller, Nicolas; Lavaux, Thomas; Ohana, Mickael; Bedo, Dimitri; Baldacini, Clement; Sagnard, Mylene; Bozman, Dogan-Firat; Della Chiesa, Margaux; Cognard, Noelle; Olagne, Jerome; Delagreverie, Heloise; Marx, David; Heibel, Francoise; Braun, Laura; Moulin, Bruno; Fafi Kremer, Samira; Caillard, Sophie

BACKGROUND Data on COVID-19 in immunocompromised kidney transplant recipients (KTR) remain scanty. Although markers of inflammation, cardiac injury, and coagulopathy have been previously associated with mortality in the general population of patients with COVID-19, their prognostic impact amongst KTR with SARS-CoV-2 infection has not been specifically investigated. METHODS We conducted a cohort study of 49 KTR who presented with COVID-19. Clinical and laboratory risk factors for severe disease and mortality were prospectively collected and analyzed with respect to outcomes. The study participants were divided into 3 groups: 1) mild disease manageable in an outpatient setting (n = 8), 2) nonsevere disease requiring hospitalization (n = 21), and 3) severe disease (n = 20). RESULTS Gastrointestinal manifestations were common at diagnosis. The 30-day mortality rate in hospitalized patients was 19.5%. Early elevations of C-reactive protein (>100 mg/L) and interleukin-6 (>65 ng/L) followed by increases in high-sensitivity troponin I (>30 ng/L) and D-dimer (>960 ng/mL) were significantly associated with severe disease and mortality. Viral load did not have prognostic significance in our sample, suggesting that outcomes were chiefly driven by a cytokine release syndrome (CRS). CONCLUSION Regular monitoring of CRS biomarkers in KTR with COVID-19 is paramount to improve clinical outcomes.