title: Clinical Progression and Cytokine Profiles of Middle East Respiratory Syndrome Coronavirus Infection.
abstract: Clinical progression over time and cytokine profiles have not been well defined in patients with Middle East respiratory syndrome coronavirus (MERS-CoV) infection. We included 17 patients with laboratory-confirmed MERS-CoV during the 2015 outbreak in Korea. Clinical and laboratory parameters were collected prospectively. Serum cytokine and chemokine levels in serial serum samples were measured using enzyme-linked immunosorbent assay. All patients presented with fever. The median time to defervescence was 18 days. Nine patients required oxygen supplementation and classified into severe group. In the severe group, chest infiltrates suddenly began to worsen around day 7 of illness, and dyspnea developed at the end of the first week and became apparent in the second week. Median time from symptom onset to oxygen supplementation was 8 days. The severe group had higher neutrophil counts during week 1 than the mild group (4,500 vs. 2,200/μL, P = 0.026). In the second week of illness, the severe group had higher serum levels of IL-6 (54 vs. 4 pg/mL, P = 0.006) and CXCL-10 (2,642 vs. 382 pg/mL, P < 0.001). IFN-α response was not observed in mild cases. Our data shows that clinical condition may suddenly deteriorate around 7 days of illness and the serum levels of IL-6 and CXCL-10 was significantly elevated in MERS-CoV patients who developed severe diseases.
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Eu Suk
authors.identifier: http://orcid.org/0000-0001-7132-0157
authors.initials: ES
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Pyoeng Gyun
authors.identifier: http://orcid.org/0000-0001-6794-7918
authors.initials: PG
authors.lastname: Choe
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Wan Beom
authors.identifier: http://orcid.org/0000-0003-0022-9625
authors.initials: WB
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hong Sang
authors.identifier: http://orcid.org/0000-0002-4535-6305
authors.initials: HS
authors.lastname: Oh
authors.forename: Eun Jung
authors.identifier: http://orcid.org/0000-0003-3302-7827
authors.initials: EJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Eun Young
authors.identifier: http://orcid.org/0000-0003-2488-3226
authors.initials: EY
authors.lastname: Nam
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Sun Hee
authors.identifier: http://orcid.org/0000-0002-9605-7807
authors.initials: SH
authors.lastname: Na
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Moonsuk
authors.identifier: http://orcid.org/0000-0001-8640-939X
authors.initials: M
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Kyoung Ho
authors.identifier: http://orcid.org/0000-0002-4517-3840
authors.initials: KH
authors.lastname: Song
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Ji Hwan
authors.identifier: http://orcid.org/0000-0002-7628-1182
authors.initials: JH
authors.lastname: Bang
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Sang Won
authors.identifier: http://orcid.org/0000-0002-0550-1897
authors.initials: SW
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hong Bin
authors.identifier: http://orcid.org/0000-0001-6262-372X
authors.initials: HB
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Nam Joong
authors.identifier: http://orcid.org/0000-0001-6793-9467
authors.initials: NJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. mdohmd@snu.ac.kr.
authors.forename: Myoung Don
authors.identifier: http://orcid.org/0000-0002-2344-7695
authors.initials: MD
authors.lastname: Oh
mesh_terms: D000328:Adult; D000368:Aged; D001831:Body Temperature; D054357:Chemokine CXCL10 / Q000097:blood; D018925:Chemokines / Q000097:blood; D018352:Coronavirus Infections / Q000097:blood / Q000150:complications / Q000473:pathology*; D003404:Creatinine / Q000097:blood; D016207:Cytokines / Q000097:blood*; D018450:Disease Progression; D004417:Dyspnea / Q000209:etiology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D007371:Interferon-gamma / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology; D011517:Prothrombin Time; D012720:Severity of Illness Index
chemical_list: C114753:CXCL10 protein, human; D054357:Chemokine CXCL10; D018925:Chemokines; D016207:Cytokines; D015850:Interleukin-6; D007371:Interferon-gamma; D003404:Creatinine
keywords: CXCL-10; Chemokine; Clinical Progression; Coronavirus; Cytokine; IFN-α; IL-6; MERS; Severity