Longitudinal hematologic and immunologic variations associated with the progression of COVID-19 patients in China - 22/07/20

Doi : 10.1016/j.jaci.2020.05.003

Ruchong Chen, MD ^a,^{^{∗
These authors contributed equally as co-first authors.}}, Ling Sang, MD ^b,^{^{∗
These authors contributed equally as co-first authors.}}, Mei Jiang, PhD ^b,^{^{∗
These authors contributed equally as co-first authors.}}, Zhaowei Yang, PhD ^a,^{^{∗
These authors contributed equally as co-first authors.}}, Nan Jia, PhD ^a,^{^{∗
These authors contributed equally as co-first authors.}}, Wanyi Fu, PhD ^a,^{^{∗
These authors contributed equally as co-first authors.}}, Jiaxing Xie, MD ^a, Weijie Guan, MD ^b, Wenhua Liang, MD ^b, Zhengyi Ni, MD ^c, Yu Hu, MD ^d, Lei Liu, MD ^e, Hong Shan, MD ^f, Chunliang Lei, MD ^g, Yixiang Peng, MD ^h, Li Wei, MD ⁱ, Yong Liu, MD ^j, Yahua Hu, MD ^k, Peng Peng, MD ^l, Jianming Wang, MD ^m, Jiyang Liu, MD ⁿ, Zhong Chen, MD ^o, Gang Li, MD ^p, Zhijian Zheng, MD ^q, Shaoqin Qiu, MD ^r, Jie Luo, MD ^s, Changjiang Ye, MD ^t, Shaoyong Zhu, MD ^u, Jinping Zheng, MD ^b, Nuofu Zhang, MD ^b, Yimin Li, MD ^b, Jianxing He, MD ^b, Jing Li, MD ^a,^⁎ , Shiyue Li, MD ^b,^⁎ , Nanshan Zhong, MD ^b,^⁎
on behalf of the
Medical Treatment Expert Group for COVID-19
^a Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
^b National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
^c Wuhan Jin-yin tan Hospital, Wuhan, Hubei, China
^d Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
^e Shenzhen Third People’s Hospital, Shenzhen, China
^f The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, China
^g Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
^h The Central Hospital of Wuhan, Wuhan, Hubei, China
ⁱ Wuhan No.1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
^j Chengdu Public Health Clinical Medical Center, Chengdu, Sichuan, China
^k Huangshi Central Hospital of Edong Healthcare Group, Affiliated Hospital of Hubei Polytechnic University, Huangshi, Hubei, China
^l Wuhan Pulmonary Hospital, Wuhan, Hubei, China
^m Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei, China
ⁿ The First Hospital of Changsha, Changsha, Hunan, China
^o The Third People’s Hospital of Hainan Province, Sanya, Hainan, China
^p Huanggang Central Hospital, Huanggang, Hubei, China
^q Wenling First People’s Hospital, Wenling, Zhejiang, China
^r The Third People’s Hospital of Yichang, Yichang, Hubei
^s Affiliated Taihe Hospital of Hubei University of Medicine, Shiyan, Hubei, China
^t Xiantao First People’s Hospital, Xiantao, China
^u The People’s Hospital of Huangpi District, Wuhan, China

^∗Corresponding author: Jing Li, MD, Shiyue Li, MD, or Nanshan Zhong, MD, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Rd, Guangzhou, Guangdong 510120, China.National Clinical Research Center for Respiratory DiseaseState Key Laboratory of Respiratory DiseaseGuangzhou Institute of Respiratory Healththe First Affiliated Hospital of Guangzhou Medical University151 Yanjiang RdGuangzhouGuangdong510120China

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Abstract

Background

Crucial roles of hematologic and immunologic responses in progression of coronavirus disease 2019 (COVID-19) remain largely unclear.

Objective

We sought to address the dynamic changes in hematologic and immunologic biomarkers and their associations with severity and outcomes of COVID-19.

Methods

A retrospective study including 548 patients with COVID-19 with clarified outcome (discharged or deceased) from a national cohort in China was performed. Cross-sectional and longitudinal variations were compared and the associations with different severity and outcomes were analyzed.

Results

On admission, the counts of lymphocytes, T-cell subsets, eosinophils, and platelets decreased markedly, especially in severe/critical and fatal patients. Increased neutrophil count and neutrophils-to-lymphocytes ratio were predominant in severe/critical cases or nonsurvivors. During hospitalization, eosinophils, lymphocytes, and platelets showed an increasing trend in survivors, but maintained lower levels or dropped significantly afterwards in nonsurvivors. Nonsurvivors kept a high level or showed an upward trend for neutrophils, IL-6, procalcitonin, D-dimer, amyloid A protein, and C-reactive protein, which were kept stable or showed a downward trend in survivors. Positive correlation between CD8⁺ T-cell and lymphocytes count was found in survivors but not in nonsurvivors. A multivariate Cox regression model suggested that restored levels of lymphocytes, eosinophils, and platelets could serve as predictors for recovery, whereas progressive increases in neutrophils, basophils, and IL-6 were associated with fatal outcome.

Conclusions

Hematologic and immunologic impairment showed a significantly different profile between survivors and nonsurvivors in patients with COVID-19 with different severity. The longitudinal variations in these biomarkers could serve to predict recovery or fatal outcome.

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Graphical abstract

Il testo completo di questo articolo è disponibile in PDF.

Key words : Hematologic indices, immunologic responses, COVID-19, severity, outcome

Abbreviations used : COVID-19, CRP, HR, MERS, NLR, PCT, PLR, SAA, SARS, SARS-CoV-2

Mappa

Demographic and baseline clinical characteristics

Initial laboratory findings among hospitalized patients with different outcome and severity

Dynamic changes in hematologic and immunologic biomarkers

Correlation networks and principal-component analysis for immunologic cells and biomarkers

Predicted factors for the fatal outcome

Discussion

Conclusions

Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest.

Esportazione

Vol 146 - N° 1

P. 89-100 - Luglio 2020 Ritorno al numero

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Longitudinal hematologic and immunologic variations associated with the progression of COVID-19 patients in China - 22/07/20

Abstract

Background

Objective

Methods

Results

Conclusions

Graphical abstract

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