The following is a summary of “Transitions of blood immune endotypes and improved outcome by anakinra in COVID-19 pneumonia: an analysis of the SAVE-MORE randomized controlled trial,” published in the March 2024 issue of Critical Care by Kyriazopoulou et al.
Classifying sepsis patients by endotype could lead to more targeted immune system treatments for bacterial and viral infections.
Researchers conducted a retrospective study investigating immune profiles and their changes linked to treatment with anakinra (a human interleukin-1 receptor antagonist) in SAVE-MORE trial participants.
They analyzed adult patients hospitalized due to severe pneumonia caused by SARS-CoV-2 in the SAVE-MORE trial. Patients had plasma-soluble urokinase plasminogen activator receptor levels of ≥ 6 ng/ml. Assessed at baseline and days 4 and 7 using a 33-mRNA classifier for blood endotypes. The study aimed to monitor endotype changes and anakinra’s impact on progression to severe respiratory failure (SRF).
The results showed that of 393 patients initially, 23.2% were identified as inflammopathic, 41.1% as adaptive, and 35.7% as coagulopathic. Only 23.9% maintained their baseline endotype on days 4 and 7, with others transitioning between endotypes. Anakinra treatment notably increased the likelihood of patients remaining in the adaptive endotype throughout the 7 days (24.4% vs. 9.9%; P<0.001). Moreover, at day 7, anakinra demonstrated protective effects against SRF in patients with the coagulopathic endotype compared to placebo (27.8% vs. 55.9%; P=0.013).
Investigators concluded that prior studies linked blood immunity and anakinra response in COVID-19, suggesting anakinra pushes patients towards a better immune state.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04852-z