Mapping Interactions Between Cytokines, Chemokines, Growth Factors, and Conventional Biomarkers in COVID-19 ICU-Patients
Abstract
1. Introduction
2. Results
2.1. Patient Characteristics
2.2. Associations Between Inflammatory Biomarkers (CRP, PCT, IL-6, Ferritin) and Peripheral Blood Nucleated Cells
2.3. Associations Between CRP and CCGFs
2.4. Associations Between PCT and CCGFs
2.5. Associations Between IL6 and CCGFs
2.6. Associations Between Ferritin and CCGFs
3. Discussion
4. Materials and Methods
4.1. Study Population
4.2. Ethical Considerations
4.3. Proximity Extension Assay
4.4. STRING Images
4.5. Statistical Analysis
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Ma, Z.; Yang, K.Y.; Huang, Y.; Lui, K.O. Endothelial contribution to COVID-19: An update on mechanisms and therapeutic implications. J. Mol. Cell. Cardiol. 2022, 164, 69–82. [Google Scholar] [CrossRef] [PubMed]
- Tajbakhsh, A.; Gheibi Hayat, S.M.; Taghizadeh, H.; Akbari, A.; Inabadi, M.; Savardashtaki, A.; Johnston, T.P.; Sahebkar, A. COVID-19 and cardiac injury: Clinical manifestations, biomarkers, mechanisms, diagnosis, treatment, and follow up. Expert Rev. Anti Infect. Ther. 2021, 19, 345–357. [Google Scholar] [CrossRef]
- Hultström, M.; Lipcsey, M.; Wallin, E.; Larsson, I.M.; Larsson, A.; Frithiof, R. Severe acute kidney injury associated with progression of chronic kidney disease after critical COVID-19. Crit. Care 2021, 25, 37. [Google Scholar] [CrossRef]
- Fouladseresht, H.; Doroudchi, M.; Rokhtabnak, N.; Abdolrahimzadehfard, H.; Roudgari, A.; Sabetian, G.; Paydar, S. Predictive monitoring and therapeutic immune biomarkers in the management of clinical complications of COVID-19. Cytokine Growth Factor Rev. 2021, 58, 32–48. [Google Scholar] [CrossRef]
- Goudouris, E.S. Laboratory diagnosis of COVID-19. J. Pediatr. 2021, 97, 7–12. [Google Scholar] [CrossRef]
- Liu, F.; Li, L.; Xu, M.; Wu, J.; Luo, D.; Zhu, Y.; Li, B.; Song, X.; Zhou, X. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. J. Clin. Virol. 2020, 127, 104370. [Google Scholar] [CrossRef]
- Zhang, Z.L.; Hou, Y.L.; Li, D.T.; Li, F.Z. Laboratory findings of COVID-19: A systematic review and meta-analysis. Scand. J. Clin. Lab. Investig. 2020, 80, 441–447. [Google Scholar] [CrossRef]
- Quartuccio, L.; Fabris, M.; Sonaglia, A.; Peghin, M.; Domenis, R.; Cifù, A.; Curcio, F.; Tascini, C. Interleukin 6, soluble interleukin 2 receptor alpha (CD25), monocyte colony-stimulating factor, and hepatocyte growth factor linked with systemic hyperinflammation, innate immunity hyperactivation, and organ damage in COVID-19 pneumonia. Cytokine 2021, 140, 155438. [Google Scholar] [CrossRef]
- Bivona, G.; Agnello, L.; Ciaccio, M. Biomarkers for Prognosis and Treatment Response in COVID-19 Patients. Ann. Lab. Med. 2021, 41, 540–548. [Google Scholar] [CrossRef] [PubMed]
- Rudnicka, E.; Suchta, K.; Grymowicz, M.; Calik-Ksepka, A.; Smolarczyk, K.; Duszewska, A.M.; Smolarczyk, R.; Meczekalski, B. Chronic Low Grade Inflammation in Pathogenesis of PCOS. Int. J. Mol. Sci. 2021, 22, 3789. [Google Scholar] [CrossRef] [PubMed]
- Plebani, M. Why C-reactive protein is one of the most requested tests in clinical laboratories? Clin. Chem. Lab. Med. 2023, 61, 1540–1545. [Google Scholar] [CrossRef]
- Muhammad, J.S.; ElGhazali, G.; Shafarin, J.; Mohammad, M.G.; Abu-Qiyas, A.; Hamad, M. SARS-CoV-2-induced hypomethylation of the ferritin heavy chain (FTH1) gene underlies serum hyperferritinemia in severe COVID-19 patients. Biochem. Biophys. Res. Commun. 2022, 631, 138–145. [Google Scholar] [CrossRef] [PubMed]
- Hanff, T.C.; Mohareb, A.M.; Giri, J.; Cohen, J.B.; Chirinos, J.A. Thrombosis in COVID-19. Am. J. Hematol. 2020, 95, 1578–1589. [Google Scholar] [CrossRef] [PubMed]
- Meroni, P.L.; Croci, S.; Lonati, P.A.; Pregnolato, F.; Spaggiari, L.; Besutti, G.; Bonacini, M.; Ferrigno, I.; Rossi, A.; Hetland, G.; et al. Complement activation predicts negative outcomes in COVID-19: The experience from Northen Italian patients. Autoimmun. Rev. 2023, 22, 103232. [Google Scholar] [CrossRef] [PubMed]
- Kell, D.B.; Pretorius, E. Serum ferritin is an important inflammatory disease marker, as it is mainly a leakage product from damaged cells. Metallomics 2014, 6, 748–773. [Google Scholar] [CrossRef]
- Volfovitch, Y.; Tsur, A.M.; Gurevitch, M.; Novick, D.; Rabinowitz, R.; Mandel, M.; Achiron, A.; Rubinstein, M.; Shoenfeld, Y.; Amital, H. The intercorrelations between blood levels of ferritin, sCD163, and IL-18 in COVID-19 patients and their association to prognosis. Immunol. Res. 2022, 70, 817–828. [Google Scholar] [CrossRef]
- Maves, R.C.; Enwezor, C.H. Uses of Procalcitonin as a Biomarker in Critical Care Medicine. Infect. Dis. Clin. N. Am. 2022, 36, 897–909. [Google Scholar] [CrossRef]
- Mazaheri, T.; Ranasinghe, R.; Al-Hasani, W.; Luxton, J.; Kearney, J.; Manning, A.; Dimitriadis, G.K.; Mare, T.; Vincent, R.P. A cytokine panel and procalcitonin in COVID-19, a comparison between intensive care and non-intensive care patients. PLoS ONE 2022, 17, e0266652. [Google Scholar] [CrossRef]
- Oberhoffer, M.; Karzai, W.; Meier-Hellmann, A.; Reinhart, K. Procalcitonin. A new diagnostic parameter for severe infections and sepsis. Anaesthesist 1998, 47, 581–587. [Google Scholar] [CrossRef]
- Palladino, M. Complete blood count alterations in COVID-19 patients: A narrative review. Biochem. Med. 2021, 31, 030501. [Google Scholar] [CrossRef]
- Zhu, L.; Yang, P.; Zhao, Y.; Zhuang, Z.; Wang, Z.; Song, R.; Zhang, J.; Liu, C.; Gao, Q.; Xu, Q.; et al. Single-Cell Sequencing of Peripheral Mononuclear Cells Reveals Distinct Immune Response Landscapes of COVID-19 and Influenza Patients. Immunity 2020, 53, 685–696.e683. [Google Scholar] [CrossRef]
- Carreto-Binaghi, L.E.; Herrera, M.T.; Guzmán-Beltrán, S.; Juárez, E.; Sarabia, C.; Salgado-Cantú, M.G.; Juarez-Carmona, D.; Guadarrama-Pérez, C.; González, Y. Reduced IL-8 Secretion by NOD-like and Toll-like Receptors in Blood Cells from COVID-19 Patients. Biomedicines 2023, 11, 1078. [Google Scholar] [CrossRef] [PubMed]
- Méndez Rodríguez, M.L.; Ponciano-Gómez, A.; Campos-Aguilar, M.; Tapia-Sánchez, W.D.; Duarte-Martínez, C.L.; Romero-Herrera, J.S.; Olivas-Quintero, S.; Saucedo-Campos, A.D.; Méndez-Cruz, A.R.; Jimenez-Flores, R.; et al. Neutrophil-to-Lymphocyte Ratio and Cytokine Profiling as Predictors of Disease Severity and Survival in Unvaccinated COVID-19 Patients. Vaccines 2024, 12, 861. [Google Scholar] [CrossRef] [PubMed]
- Naylor, D.; Sharma, A.; Li, Z.; Monteith, G.; Mallard, B.A.; Bergeron, R.; Baes, C.; Karrow, N.A. Endotoxin-induced cytokine, chemokine and white blood cell profiles of variable stress-responding sheep. Stress 2021, 24, 888–897. [Google Scholar] [CrossRef]
- Gu, S.X.; Tyagi, T.; Jain, K.; Gu, V.W.; Lee, S.H.; Hwa, J.M.; Kwan, J.M.; Krause, D.S.; Lee, A.I.; Halene, S.; et al. Thrombocytopathy and endotheliopathy: Crucial contributors to COVID-19 thromboinflammation. Nat. Rev. Cardiol. 2021, 18, 194–209. [Google Scholar] [CrossRef]
- Pushkala, S.; Seshayyan, S.; Theranirajan, E.; Sudhakar, D.; Raghavan, K.; Dedeepiya, V.D.; Ikewaki, N.; Iwasaki, M.; Preethy, S.; Abraham, S.J. Efficient Control of IL-6, CRP and Ferritin in COVID-19 Patients With Two Variants of Beta-1,3-1,6 Glucans in Combination: An Open-Label, Prospective, Randomised Clinical Trial. Glob. Adv. Integr. Med. Health 2025, 14, 27536130251327134. [Google Scholar] [CrossRef]
- Atallah, N.J.; Warren, H.M.; Roberts, M.B.; Elshaboury, R.H.; Bidell, M.R.; Gandhi, R.G.; Adamsick, M.; Ibrahim, M.K.; Sood, R.; Bou Zein Eddine, S.; et al. Baseline procalcitonin as a predictor of bacterial infection and clinical outcomes in COVID-19: A case-control study. PLoS ONE 2022, 17, e0262342. [Google Scholar] [CrossRef]
- Cohen, A.J.; Glick, L.R.; Lee, S.; Kunitomo, Y.; Tsang, D.A.; Pitafi, S.; Valda Toro, P.; Ristic, N.R.; Zhang, E.; Carey, G.B.; et al. Nonutility of procalcitonin for diagnosing bacterial pneumonia in patients with severe COVID-19. Eur. Clin. Respir. J. 2023, 10, 2174640. [Google Scholar] [CrossRef] [PubMed]
- Ceccarelli, G.; Alessandri, F.; Migliara, G.; Baccolini, V.; Giordano, G.; Galardo, G.; Marzuillo, C.; De Vito, C.; Russo, A.; Ciccozzi, M.; et al. Reduced Reliability of Procalcitonin (PCT) as a Biomarker of Bacterial Superinfection: Concerns about PCT-Driven Antibiotic Stewardship in Critically Ill COVID-19 Patients-Results from a Retrospective Observational Study in Intensive Care Units. J. Clin. Med. 2023, 12, 6171. [Google Scholar] [CrossRef]
- Adachi, T.; Nonomura, S.; Horiba, M.; Hirayama, T.; Kamiya, T.; Nagasawa, H.; Hara, H. Iron stimulates plasma-activated medium-induced A549 cell injury. Sci. Rep. 2016, 6, 20928. [Google Scholar] [CrossRef]
- Azevedo, R.B.; Botelho, B.G.; Hollanda, J.V.G.; Ferreira, L.V.L.; Junqueira de Andrade, L.Z.; Oei, S.; Mello, T.S.; Muxfeldt, E.S. COVID-19 and the cardiovascular system: A comprehensive review. J. Hum. Hypertens. 2021, 35, 4–11. [Google Scholar] [CrossRef]
- Magadum, A.; Kishore, R. Cardiovascular Manifestations of COVID-19 Infection. Cells 2020, 9, 2508. [Google Scholar] [CrossRef]
- Eriksson, M.B.; Eriksson, L.B.; Larsson, A.O. Significant Interplay Between Lipids, Cytokines, Chemokines, Growth Factors, and Blood Cells in an Outpatient Cohort. Int. J. Mol. Sci. 2025, 26, 7746. [Google Scholar] [CrossRef] [PubMed]
- Burgmeijer, E.H.; Duijkers, R.; Lutter, R.; Bonten, M.J.M.; Schweitzer, V.A.; Boersma, W.G. Plasma cytokine profile on admission related to aetiology in community-acquired pneumonia. Clin. Respir. J. 2019, 13, 605–613. [Google Scholar] [CrossRef]
- Lee, S.; Channappanavar, R.; Kanneganti, T.D. Coronaviruses: Innate Immunity, Inflammasome Activation, Inflammatory Cell Death, and Cytokines. Trends Immunol. 2020, 41, 1083–1099. [Google Scholar] [CrossRef] [PubMed]
- Azoulay, E.; Metnitz, B.; Sprung, C.L.; Timsit, J.F.; Lemaire, F.; Bauer, P.; Schlemmer, B.; Moreno, R.; Metnitz, P. End-of-life practices in 282 intensive care units: Data from the SAPS 3 database. Intensive Care Med. 2009, 35, 623–630. [Google Scholar] [CrossRef] [PubMed]
- Moreno, R.P.; Metnitz, P.G.; Almeida, E.; Jordan, B.; Bauer, P.; Campos, R.A.; Iapichino, G.; Edbrooke, D.; Capuzzo, M.; Le Gall, J.R. SAPS 3—From evaluation of the patient to evaluation of the intensive care unit. Part 2: Development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med. 2005, 31, 1345–1355. [Google Scholar] [CrossRef]
- Larsson, A.O.; Hultström, M.; Frithiof, R.; Lipcsey, M.; Eriksson, M.B. Shrunken Pore Syndrome Is Frequently Occurring in Severe COVID-19. Int. J. Mol. Sci. 2022, 23, 15687. [Google Scholar] [CrossRef]
- WMA Declaration of Helsinki—Ethical Principles for Medical Research Involving Human Subjects. Available online: https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects (accessed on 23 March 2022).
- Benjamini, Y.; Hochberg, Y. Controlling the False Discovery Rate: A Practical and Powerful Approach to Multiple Testing. J. R. Stat. Soc. Ser. B (Methodol.) 2018, 57, 289–300. [Google Scholar] [CrossRef]
- Skau, E.; Wagner, P.; Leppert, J.; Ärnlöv, J.; Hedberg, P. Are the results from a multiplex proteomic assay and a conventional immunoassay for NT-proBNP and GDF-15 comparable? Clin. Proteom. 2023, 20, 5. [Google Scholar] [CrossRef]
- STRING: Functional Protein Association Networks. Available online: https://string-db.org (accessed on 1 February 2025).





| Biomarker | CCGFs | p-Values | Benjamini–Hochberg Significance | Benjamini–Hochberg p-Value |
|---|---|---|---|---|
| Basophil | Gal9 | 0.001026 | significant | 0.02642037 |
| Basophil | RAGE | 0.000916 | significant | 0.02424253 |
| Eosinophil | TNFRSF13B | 0.000654 | significant | 0.01884023 |
| Eosinophil | Gal9 | 0.004025 | significant | 0.05629887 |
| Eosinophil | RAGE | 0.003435 | significant | 0.05095177 |
| Leucocyte | ADAMTS13 | 0.002680 | significant | 0.0444628 |
| Leucocyte | GIF | 0.001105 | significant | 0.02775048 |
| Leucocyte | IL16 | 0.003129 | significant | 0.04925209 |
| Leucocyte | CEACAM8 | 0.000155 | significant | 0.00583731 |
| Lymphocyte | CTRC | 0.004319 | significant | 0.05920063 |
| Monocyte | THPO | 0.007095 | significant | 0.08904599 |
| Monocyte | CTSL1 | 0.000873 | significant | 0.02374733 |
| Monocyte | TM | 0.001577 | significant | 0.03375487 |
| Neutrophil | ADAMTS13 | 0.001931 | significant | 0.03665511 |
| CRP | IL6 | 0.000429 | significant | 0.01354379 |
| CRP | CTSL1 | 0.006987 | significant | 0.08883657 |
| CRP | IL1Ra | 0.003948 | significant | 0.0560123 |
| CRP | SCF | 0.000631 | significant | 0.01871042 |
| CRP | PRELP | 0.008027 | significant | 0.09823623 |
| CRP | DCN | 0.004414 | significant | 0.05920063 |
| Procalcitonin | ADM | 0.000084 | significant | 0.00533579 |
| Procalcitonin | CRP | 0.000113 | significant | 0.00533579 |
| Procalcitonin | IL6 | 0.002820 | significant | 0.04525296 |
| Procalcitonin | PGF | 0.000142 | significant | 0.00555488 |
| Procalcitonin | PDL2 | 0.000224 | significant | 0.00804027 |
| Procalcitonin | CTSL1 | 0.000052 | significant | 0.00422464 |
| Procalcitonin | LEP | 0.002546 | significant | 0.0444628 |
| Procalcitonin | CA5A | 0.001341 | significant | 0.03281978 |
| Procalcitonin | CD4 | 0.000230 | significant | 0.00804027 |
| Procalcitonin | PARP1 | 0.002607 | significant | 0.0444628 |
| Procalcitonin | IL1ra | 0.001637 | significant | 0.03409022 |
| Procalcitonin | TNFRSF10A | 0.000005 | significant | 0.00091348 |
| Procalcitonin | TRAILR2 | 0.001493 | significant | 0.03375487 |
| Procalcitonin | IL18 | 0.007520 | significant | 0.09318602 |
| Procalcitonin | SPON2 | 0.005478 | significant | 0.07056722 |
| Procalcitonin | TM | 0.005266 | significant | 0.06966781 |
| Procalcitonin | CEACAM8 | 0.000477 | significant | 0.01457828 |
| Procalcitonin | CCL3 | 0.000257 | significant | 0.00867255 |
| Procalcitonin | HBEGF | 0.003396 | significant | 0.05095177 |
| IL6 | ADM | 0.002004 | significant | 0.03702356 |
| IL6 | CRP | 0.000429 | significant | 0.01354379 |
| IL6 | PCT | 0.002820 | significant | 0.04525296 |
| IL6 | TNFRSF11A | 0.005383 | significant | 0.07026409 |
| IL6 | TRAILR2 | 0.002533 | significant | 0.0444628 |
| IL6 | CCL3 | 0.001488 | significant | 0.03375487 |
| Ferritin | CTSL1 | 0.000806 | significant | 0.02255561 |
| Ferritin | TGM2 | 0.003699 | significant | 0.05325795 |
| Ferritin | LEP | 0.001493 | significant | 0.03375487 |
| Ferritin | CA5A | 0.003525 | significant | 0.05150071 |
| Ferritin | PARP1 | 0.000019 | significant | 0.00209397 |
| Ferritin | HAOX1 | 0.001544 | significant | 0.03375487 |
| Ferritin | IL18 | 0.000031 | significant | 0.0030732 |
| Ferritin | GLO1 | 0.004384 | significant | 0.05920063 |
| Ferritin | HO1 | 0.000140 | significant | 0.00555488 |
| Ferritin | AGRP | 0.001586 | significant | 0.03375487 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Eriksson, M.B.; Marks-Hultström, M.; Åberg, M.; Lipcsey, M.; Frithiof, R.; Larsson, A.O. Mapping Interactions Between Cytokines, Chemokines, Growth Factors, and Conventional Biomarkers in COVID-19 ICU-Patients. Int. J. Mol. Sci. 2025, 26, 11419. https://doi.org/10.3390/ijms262311419
Eriksson MB, Marks-Hultström M, Åberg M, Lipcsey M, Frithiof R, Larsson AO. Mapping Interactions Between Cytokines, Chemokines, Growth Factors, and Conventional Biomarkers in COVID-19 ICU-Patients. International Journal of Molecular Sciences. 2025; 26(23):11419. https://doi.org/10.3390/ijms262311419
Chicago/Turabian StyleEriksson, Mats B., Michael Marks-Hultström, Mikael Åberg, Miklós Lipcsey, Robert Frithiof, and Anders O. Larsson. 2025. "Mapping Interactions Between Cytokines, Chemokines, Growth Factors, and Conventional Biomarkers in COVID-19 ICU-Patients" International Journal of Molecular Sciences 26, no. 23: 11419. https://doi.org/10.3390/ijms262311419
APA StyleEriksson, M. B., Marks-Hultström, M., Åberg, M., Lipcsey, M., Frithiof, R., & Larsson, A. O. (2025). Mapping Interactions Between Cytokines, Chemokines, Growth Factors, and Conventional Biomarkers in COVID-19 ICU-Patients. International Journal of Molecular Sciences, 26(23), 11419. https://doi.org/10.3390/ijms262311419

