The underlying changes and predicting role of peripheral blood inflammatory cells in severe COVID-19 patients: a sentinel?

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Highlights

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Lymphopenia and eosinopenia might be predictors of disease severity in COVID-19.
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Lymphopenia and eosinopenia might be predictors of disease progression in COVID-19.
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Clinical classification-severe type is the dependently risk factor for alteration of PBICs.
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PBICs might be a sentinel, and it deserves attention during COVID-19 management.

Abstract

Background

The underlying changes of peripheral blood inflammatory cells (PBICs) in COVID-19 patients are little known. Moreover, the risk factors for the underlying changes of PBICs and their predicting role in severe COVID-19 patients remain uncertain.

Material and Methods

This retrospective study including two cohorts: the main cohort enrolling 45 patients of severe type serving as study group, and the secondary cohort enrolling 12 patients of no-severe type serving as control group. The PBICs analysis was based on blood routine and lymphocyte subsets. The inflammatory cell levels were compared among patients according to clinical classifications, disease-associated phases, as well as one-month outcomes.

Results

Compared with patients of non-severe type, the patients of severe type suffered from significantly decreased counts of lymphocytes, eosinophils, basophils, but increased counts of neutrophils. These PBICs alterations got improved in recovery phase, but persisted or got worse in aggravated phase. Compared with patients in discharged group, the patients in un-discharged/died group suffered from decreased counts of total T lymphocytes, CD4+T lymphocytes, CD8+T lymphocytes, as well as NK cells at 2 weeks after treatment. Clinical classification-critically severe was the independently risk factor for lymphopenia ( OR=7.701, 95%CI:1.265-46.893, P=0.027), eosinopenia ( OR=5.595, 95%CI:1.008-31.054, P=0.049) and worse one-month outcome ( OR=8.984; 95%CI:1.021-79.061, P=0.048).

Conclusion

Lymphopenia and eosinopenia may serve as predictors of disease severity and disease progression in COVID-19 patients, and enhancing the cellular immunity may contribute to COVID-19 treatment. Thus, PBICs might become a sentinel of COVID-19, and it deserves attention during COVID-19 treatment.

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Most cited references 39

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Clinical Characteristics of Coronavirus Disease 2019 in China

Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)

Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)

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Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Fei Zhou, Ting Yu, Ronghui Du … (2020)

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

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Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention

Zunyou Wu, Jennifer M. McGoogan (2020)

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Author and article information

Contributors

Da-wei Sun

Dong Zhang

Run-hui Tian

Yang Li

Yu-shi Wang

Jie Cao

Ying Tang

Nan Zhang

Tao Zan

Lan Gao

Yan-zhu Huang

Chang-lei Cui

Dong-xuan Wang

Yang Zheng

Guo-yue Lv

Journal

Journal ID (nlm-ta): Clin Chim Acta

Journal ID (iso-abbrev): Clin. Chim. Acta

Title: Clinica Chimica Acta; International Journal of Clinical Chemistry

Publisher: Elsevier B.V.

ISSN (Print): 0009-8981

ISSN (Electronic): 1873-3492

Publication date PMC-release: 14 May 2020

Publication date (Electronic): 14 May 2020

Affiliations

[a ]Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin, China

[b ]Department of Intensive Care Unit, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin, China

[c ]Department of psychology, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin, China

[d ]Department of Thoracic surgery, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin, China

[e ]Department of Cardiology, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin, China

[f ]Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin, China

[g ]Department of respiration, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin, China

[h ]Department of Gastroenterology, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin, China

[i ]Department of Neurology, Tongji hospital affiliated to Huazhong University of Science and Technology, Wuhan 430030, China

[j ]Department of Anesthesiology, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin, China

[k ]Department of Ultrasound, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin, China

Author notes

[* ]Corresponding author at: Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin, China. lvguoyue@ 123456sina.com

Article

Publisher ID: S0009-8981(20)30224-2

DOI: 10.1016/j.cca.2020.05.027

PMC ID: 7224669

PubMed ID: 32417210

SO-VID: 9ad8efec-96fc-4180-b403-48e2ccc86805

License:

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

History

Date received : 4 April 2020

Date revision received : 22 April 2020

Date accepted : 12 May 2020

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