Comparative immune profiling of acute respiratory distress syndrome patients with or without SARS-CoV-2 infection

Cell Rep Med. 2021 Jun 15;2(6):100291. doi: 10.1016/j.xcrm.2021.100291. Epub 2021 May 6.


Acute respiratory distress syndrome (ARDS) is the main complication of coronavirus disease 2019 (COVID-19), requiring admission to the intensive care unit (ICU). Despite extensive immune profiling of COVID-19 patients, to what extent COVID-19-associated ARDS differs from other causes of ARDS remains unknown. To address this question, here, we build 3 cohorts of patients categorized in COVID-19-ARDS+, COVID-19+ARDS+, and COVID-19+ARDS-, and compare, by high-dimensional mass cytometry, their immune landscape. A cell signature associating S100A9/calprotectin-producing CD169+ monocytes, plasmablasts, and Th1 cells is found in COVID-19+ARDS+, unlike COVID-19-ARDS+ patients. Moreover, this signature is essentially shared with COVID-19+ARDS- patients, suggesting that severe COVID-19 patients, whether or not they experience ARDS, display similar immune profiles. We show an increase in CD14+HLA-DRlow and CD14lowCD16+ monocytes correlating to the occurrence of adverse events during the ICU stay. We demonstrate that COVID-19-associated ARDS displays a specific immune profile and may benefit from personalized therapy in addition to standard ARDS management.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • COVID-19 / complications
  • COVID-19 / pathology*
  • COVID-19 / virology
  • Cohort Studies
  • Evolution, Molecular
  • Female
  • HLA-DR Antigens / metabolism
  • Humans
  • Intensive Care Units
  • Leukocytes, Mononuclear / cytology
  • Leukocytes, Mononuclear / immunology
  • Leukocytes, Mononuclear / metabolism*
  • Lipopolysaccharide Receptors / metabolism
  • Machine Learning
  • Male
  • Middle Aged
  • Monocytes / cytology
  • Monocytes / immunology
  • Monocytes / metabolism
  • Respiratory Distress Syndrome / etiology
  • Respiratory Distress Syndrome / immunology*
  • Respiratory Distress Syndrome / pathology
  • SARS-CoV-2 / isolation & purification
  • Sialic Acid Binding Ig-like Lectin 1 / metabolism
  • Th1 Cells / cytology
  • Th1 Cells / immunology
  • Th1 Cells / metabolism


  • HLA-DR Antigens
  • Lipopolysaccharide Receptors
  • Sialic Acid Binding Ig-like Lectin 1