الفهرس 
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Abstract
In December 2019, China reported a cluster of pneumonia cases caused by a novel coronavirus related to the agent of severe acute respiratory syndrome and was termed SARS Coronavirus-19 (SARS-CoV-2) (Giamarellos-Bourboulis et al., 2020).
Patients with severe COVID-19 develop a pathological state termed cytokine release syndrome (CRS) that is characterized by dysregulated immune response. which may predispose to ARDS, multi-organ failure and death (Furlow, 2020).
Interleukin-10 (IL-10) acts as an anti-inflammatory cytokine; and is essential for immune system homeostasis and inflammatory response modulation. However, High serum IL-10 can predict poor outcomes in COVID-19 patients. Hence, IL-10 might play a role in COVID-19 disease progression. Early induction of IL-10 upon SARS-CoV-2 infection during the initiation phase in the lung might represent a negative feedback mechanism that serves as a counter measure to inflammation caused by other proinflammatory mediators. However, as IL-10 production increases, it might function as an immune activating/proinflammatory agent that stimulates the production of other mediators of the cytokine storm (Lu et al., 2021).
Pulmonary Fibrosis is one of the most important complications of COVID-19 infection. Interleukin 10 also has a potent anti-fibrotic activity (Steen et al., 2020).
In our study, we evaluated the effect of serum Interleukin 10 on patients’ clinical outcome, severity of COVID-19 related symptoms and the incidence of post-COVID19 pulmonary fibrosis (PCPF).
Our study showed a significant increase in COVID pneumonia with increasing age. However, smoking had no significant effect on the development of pneumonia.
There was no statistically significant difference between the two studied groups as regard past medical history. However, there was a significant increase in fever, cough, dyspnea, and bony aches in patients with COVID pneumonia compared to patients with COVID without pneumonia with (P = 0.011, 0.009, <0.001 and 0.001 respectively).
Also, there was a significant increase in oxygen demand and significant decrease in oxygen saturation in patients with COVID pneumonia compared with patients without pneumonia. (P<0.001).
In terms of routine laboratory investigations, a statistically significant increase in AST, ALT and Hemoglobin in group I (COVID patients with pneumonia) compared to group II (COVID patients without pneumonia) (P 0.015, 0.001 and 0.048 respectively).
In additions, there was a statistically significant increase in IL-10 in patients with COVID pneumonia compared to patients without COVID pneumonia. (P<0.001).
We also compared between the two studied groups concerning score of severity and seven category ordinal score. As regard severity in patients with COVID pneumonia, 58% were severe, 24 % were moderate and 18 % were mild cases, while all the COVID patients without pneumonia are mild cases. (P<0.001). Seven category ordinal score demonstrated that most of the patients with COVID pneumonia were hospitalized and requiring nasal oxygen therapy (34%), noninvasive mechanical ventilation (54%). Meanwhile, it demonstrated that most patients of COVID without pneumonia were hospitalized (80%) but with no need for supplemental oxygen.
In order to calculate the severity of affection of the lung with pnumonia. The following scoring system was applied to each of the 5 lung lobes (3 on the right and 2 on the left):
0-25% affection of each lobe >> score 1 for each.
25-50% affection of each lobe >> score 2 for each.
50-75% affection of each lobe>> score 3 for each.
75-100% affection of each lobe>> Score 4 for each.
Following that, grading of severity was done:
grade 0 score of 0 (No abnormality present on CT)
grade I score of 1–5
grade II score of 6–15
grade III score of 16–20
The above mentioned calculation revealed that, 32 (64%) patients were having grade II lung involvement, 17 (34%) having grade I, and 2% having grade III lung involvement.
Also, results showed that among age, serum IL-10, AST, ALT in which elevated serum IL-10 was the strongest predictive of pneumonia (P=0.32).
35 of patients with COVID pneumonia developed fibrosis in follow up CT after 3 months, while 11 patients didn’t develop fibrosis. Fibrosis appeared in CTs in the form of ground glass opacities in 31 patients (88.6% of cases), reticulations 29 patients (82.9.5% of cases), traction bronchiectasis 14 patients (40% of cases) and Honey combing 2 patients (5.7 % of cases). Putting in concideration that one patient can have more than one picture of fibrosis in the same lung field.
Our study revealed that there was a statistically significant correlation between the presence of hypertension and the development of lung fibrosis. (P<0.001).
Meanwhile, there was a higher O2 demand and less mean SO2 in patients with fibrosis compared to patients with no fibrosis. However, the results were not statistically significant.
On correlating between fibrosis and lab investigation, results demonstrated that CRP, ferritin, and D. Dimer are higher in patients who developed fibrosis in follow up CT. However, the results were not statistically significant. However, there was an elevated BUN in patients with fibrosis (P=0.013).