Peripheral Plasma Cells Associated with Mortality Benefit in Severe COVID-19: A Marker of Disease Resolution - 31/07/21
, Emily Molina, MD a, ⁎, Kunbo Wang, MS b, Thomas Kickler, MD c, Yanxun Xu, PhD b, Brian T. Garibaldi, MD a, d
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Abstract |
Background |
Cytokines seen in severe coronavirus disease 2019 (COVID-19) are associated with proliferation, differentiation, and survival of plasma cells. Plasma cells are not routinely found in peripheral blood, though may produce virus-neutralizing antibodies in COVID-19 later in the course of an infection.
Methods |
Using the Johns Hopkins COVID-19 Precision Medicine Analytics Platform Registry, we identified hospitalized adult patients with confirmed severe acute respiratory coronavirus 2 (SARS-CoV-2) infection and stratified by presence of plasma cells and World Health Organization (WHO) disease severity. To identify plasma cells, we employed a sensitive flow cytometric screening method for highly fluorescent lymphocytes and confirmed these microscopically. Cox regression models were used to evaluate time to death and time to clinical improvement by the presence of plasma cells in patients with severe disease.
Results |
Of 2301 hospitalized patients with confirmed infection, 371 had plasma cells identified. Patients with plasma cells were more likely to have severe disease, though 86.6% developed plasma cells after onset of severe disease. In patients with severe disease, after adjusting for age, sex, body mass index, race, and other covariates associated with disease severity, patients with plasma cells had a reduced hazard of death (adjusted hazard ratio: 0.57; 95% confidence interval: 0.38-0.87; P value: .008). There was no significant association with the presence of plasma cells and time to clinical improvement.
Conclusions |
Patients with severe disease who have detectable plasma cells in the peripheral blood have improved mortality despite adjusting for known covariates associated with disease severity in COVID-19. Further investigation is warranted to understand the role of plasma cells in the immune response to COVID-19.
Le texte complet de cet article est disponible en PDF.Keywords : Convalescent plasma, COVID-19, Mortality, Plasma cells, plasmacytosis
Plan
| Funding: This work was supported by funding from Hopkins in Health, the Johns Hopkins Precision Medicine Program through JH-CROWN and the COVID-19 Administrative Supplement for the HHS Region 3 Treatment Center from the Office of the Assistant Secretary for Preparedness and Response (to BTG, KW, and YX). The funders were not in involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. |
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| Conflicts of Interest: BTG is a member of the Food and Drug Administration Pulmonary and Asthma Drug Advisory Committee and a consultant for Janssen Research and Development, LLC. These arrangements have been reviewed and approved by Johns Hopkins University in accordance with its conflict-of-interest policies. MB, EM, KW, TK, YX report none. |
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| Authorship: All authors had access to the data and a role in writing this manuscript. |
Vol 134 - N° 8
P. 1029-1033 - août 2021 Retour au numéro
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