Objectives: The longitudinal characterization and risk of poor outcomes related to cytokine overproduction in critical coronavirus disease 2019 (COVID-19) patients with hyperinflammation in bronchoalveolar lavage requires further investigation. Methods: We enrolled two critically ill patients with comorbidities diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detected by RT-PCR during hospitalization. Clinical characteristics, longitudinal immunological, and biochemical parameters of each critical COVID-19 case were collected. Main Results: The clinical characteristics and laboratory results of each case demonstrated critical symptoms of COVID-19 with poor outcomes. Both nasopharyngeal swabs and bronchoalveolar lavage fluid (BALF) samples tested positive for SARS-CoV-2. Two patients received targeted treatments against pathogen infection and inflammation in addition to interventional therapies, except for Patient 2, who received an additional artificial liver system treatment. Hyperinflammation with a dominantly high level of IL-6 was observed in BALF samples from both critical cases with decreased T cell populations. High levels of cytokines and pathological parameters were successively maintained in Patient 1, but rapidly reduced at the late treatment stage in Patient 2. The outcome of Patient 1 is death, whereas the outcome of Patient 2 is recovery. Conclusions: This case report suggests that a high risk of poor outcomes was related to a heavily hyperinflammatory milieu in both the blood and lungs of critical COVID-19 patients. The artificial liver intervention on cytokines overproduction might be beneficial for the recovery of critical COVID-19 patients as a reliable therapy that can be coordinated with targeted treatments, which ought to be further tested in adequately designed and powered clinical trials.

中文翻译：

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细胞因子过量产生的纵向特征：支气管肺泡灌洗中出现过度炎症的重症 COVID-19 患者的病例报告。

目的：需要进一步研究2019年冠状病毒病（COVID-19）重症患者支气管肺泡灌洗期间出现过度炎症的纵向特征和与细胞因子过量产生相关的不良结果的风险。方法：我们纳入了两名患有合并症的危重患者，在住院期间通过 RT-PCR 检测诊断为严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）。收集了每个重症 COVID-19 病例的临床特征、纵向免疫学和生化参数。主要结果：每个病例的临床特征和实验室结果均显示出 COVID-19 的危重症状，且预后不佳。鼻咽拭子和支气管肺泡灌洗液 (BALF) 样本的 SARS-CoV-2 检测结果均呈阳性。两名患者除了介入治疗外，还接受了针对病原体感染和炎症的靶向治疗，除2号患者额外接受了人工肝系统治疗外。在两个 T 细胞数量减少的危重病例的 BALF 样本中观察到高度炎症，IL-6 水平显着升高。患者1的细胞因子和病理参数持续维持在高水平，但在患者2的治疗后期迅速降低。患者1的结果是死亡，而患者2的结果是康复。结论：本病例报告表明，重症 COVID-19 患者的不良结果的高风险与血液和肺部的严重高炎症环境有关。针对细胞因子过度产生的人工肝干预可能有利于危重 COVID-19 患者的康复，作为一种可以与靶向治疗相协调的可靠疗法，应该在充分设计和有力的临床试验中进行进一步测试。