PURPOSE: The aim was to verify the impact of obesity on the long-term outcome of patients with severe SARS-CoV-2 ARDS. MATERIALS AND METHODS: The retrospective study included patients admitted to the high-volume ECMO centre between March 2020 and March 2022. The impact of body mass index (BMI), co-morbidities and therapeutic measures on the short and 90-day outcomes was analysed. RESULTS: 292 patients were included, of whom 119(40.8%) were treated with veno-venous ECMO cannulated mostly (73%) in a local hospital. 58.5% were obese (64.7% on ECMO), the ECMO was most frequent in BMI > 40(49%). The ICU mortality (36.8% for obese vs 33.9% for the non-obese, p = 0.58) was related to ECMO only for the non-obese (p = 0.04). The 90-day mortalities (48.5% obese vs 45.5% non-obese, p = 0.603) of the ECMO and non-ECMO patients were not significantly influenced by BMI (p = 0.47, p = 0.771, respectively). The obesity associated risk factors for adverse outcome were age <50 (RR 2.14) and history of chronic immunosuppressive therapy (RR 2.11, p = 0.009). The higher dosage of steroids (RR 0.57, p = 0.05) associated with a better outcome. CONCLUSIONS: The high incidence of obesity was not associated with worse short and long-term outcomes. ECMO in obese patients together with the use of steroids in the later stage of ARDS may improve survival.

• Klíčová slova
• Corticosteroids, Covid-19, Extracorporeal membrane oxygenation, Morbid obesity, Obesity, SARS-CoV-2 ARDS,
• MeSH
• COVID-19 * terapie   MeSH
• hormony kůry nadledvin terapeutické užití   MeSH
• lidé MeSH
• obezita komplikace   MeSH
• retrospektivní studie MeSH
• SARS-CoV-2 MeSH
• syndrom dechové tísně * terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• hormony kůry nadledvin MeSH

Severe influenza infection has no effective treatment available. One of the key barriers to developing host-directed therapy is a lack of reliable prognostic factors needed to guide such therapy. Here, we use a network analysis approach to identify host factors associated with severe influenza and fatal outcome. In influenza patients with moderate-to-severe diseases, we uncover a complex landscape of immunological pathways, with the main changes occurring in pathways related to circulating neutrophils. Patients with severe disease display excessive neutrophil extracellular traps formation, neutrophil-inflammation and delayed apoptosis, all of which have been associated with fatal outcome in animal models. Excessive neutrophil activation correlates with worsening oxygenation impairment and predicted fatal outcome (AUROC 0.817-0.898). These findings provide new evidence that neutrophil-dominated host response is associated with poor outcomes. Measuring neutrophil-related changes may improve risk stratification and patient selection, a critical first step in developing host-directed immune therapy.

• MeSH
• aktivace neutrofilů imunologie   MeSH
• buněčný cyklus imunologie   MeSH
• chřipka lidská imunologie   mortalita   patologie   MeSH
• exprese genu genetika   MeSH
• extracelulární pasti imunologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• neutrofily imunologie   MeSH
• plíce imunologie   MeSH
• prospektivní studie MeSH
• respirační insuficience mortalita   patologie   virologie   MeSH
• umělé dýchání MeSH
• virus chřipky A, podtyp H1N1 imunologie   izolace a purifikace   MeSH
• virus chřipky A, podtyp H3N2 imunologie   izolace a purifikace   MeSH
• virus chřipky B imunologie   izolace a purifikace   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH