Paradoxically Increased Inflammation in Immunosuppressed Individuals with COVID-19

Abstract Dysregulated inflammation is central to the morbidity and mortality associated with COVID-19. Treatment dexamethasone IL-6 blockade can be life-saving in patients stratified for moderate - severe disease. Patients suppressed immunity are often excluded from immune therapy due assumption that additional suppression of an impaired system will detrimental viral clearance. We hypothesised systems would slower clear infection, leading increased damage therefore, paradoxically, a more intense acute phase response SARS-CoV-2 infection. This was tested by sub-group analysis Coronavirus Immune Response Clinical Outcomes (CIRCO) cohort, observational study COVID-19 Greater Manchester, UK. were included if they treated had research blood sample retrieved within 48 hours admission, or antiviral prior sampling. Acute serum cytokine levels compared between eight immunosuppressed 12 immunocompetent positive SARS-CoV-2. In support our hypothesis, we found individuals higher inflammatory cytokines IP-10 (p=0.03) MCP-1 (p=0.01) matched severity. suggests may benefit as much systemic treatments dampen COVID-19, current recommendations excluding these treatment solely on basis competence need re-evaluated.