Comparative immune profiling of acute respiratory distress syndrome patients with or without SARS-CoV2 infection.

Acute respiratory distress syndrome (ARDS) is the main complication of COVID-19, requiring admission to 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, we build 3 cohorts of patients categorize in COVID-19negARDSpos, COVID-19posARDSpos, and COVID-19posARDSneg, and compare their immune landscape analyze by high-dimensional mass cytometry on peripheral blood. A cell signature associating S100A9/calprotectin-producing CD169pos monocytes, plasmablasts, and Th1 cells is found in COVID-19posARDSpos, unlike COVID-19negARDSpos patients. Moreover, this signature is essentially share with COVID-19posARDSneg patients, suggesting that severe COVID-19 patients, whatever they experience or not ARDS, display similar immune profiles. We show an increase in CD14posHLA-DRlow and CD14lowCD16pos monocytes correlate to the occurrence of adverse events during ICU stay. We demonstrate that COVID-19-associated ARDS display a specific immune profile, and might benefit from personalize therapy in addition to standard ARDS management.