Characteristics of lymphocyte subsets and cytokine profiles of patients with COVID-19

Abstract

Background Abnormalities of lymphocyte subsets and cytokine profiles have been observed in most patients with coronavirus disease (COVID-19). Here, we explore the role of lymphocyte subsets and cytokines on hospital admission in predicting the severity of COVID-19. Methods This study included 214 patients with COVID-19 who were treated at Chongqing University Three Gorges Hospital from January 19, 2020 to April 30, 2020. Any mutants were not detected in the studied patients. Patients were divided into non-intensive care unit (ICU) (mild/moderate) group and ICU (severe/critical) group, according to the severity of the disease. Clinical and laboratory data, including peripheral lymphocyte subsets and cytokines, were analyzed and compared. Logistic regression was used to analyze the predictive factors for ICU admission. Receiver operating characteristic (ROC) curves were drawn to evaluate the predictive value of selected indicators for the severity of COVID-19. Results Of the 214 patients enrolled, 161 were non-ICU patients and 53 were ICU patients. Lymphopenia was observed in nearly all of ICU patients (96.2%) and 84.5% of non-ICU patients on hospital admission. The absolute number of lymphocytes, CD3+ T cells, CD4+ T cells, CD8+ T cells, CD19+ B cells, and natural killer (NK) cells were lower in ICU group (659.00 × 106/L, 417.00 × 106/L, 261.00 × 106/L, 140.00 × 106/L, 109.00 × 106/L, 102.00 × 106/L, respectively) than in non-ICU group (1063.00 × 109/L, 717.00 × 106/L, 432.00 × 106/L, 271.00 × 106/L, 133.00 × 106/L, 143.00 × 106/L, respectively). Interleukin (IL)-6 was significantly higher in ICU patients than in non-ICU patients (18.08 pg/mL vs. 3.13 pg/mL, P < 0.001). Multivariate logistic regression analysis showed that age (odds ratio: 1.067 [1.034–1.101]), diabetes mellitus (odds ratio: 9.154 [2.710–30.926]), CD3+ T cells (odds ratio: 0.996 [0.994–0.997]), and IL-6 (odds ratio: 1.006 [1.000–1.013]) were independent predictors for the development of severe disease. ROC curve analysis showed that the area under the ROC curve (AUC) of CD3+ T cells and IL-6 was 0.806 (0.737–0.874) and 0.785 (0.705–0.864), respectively, and the cutoff values were 510.50 × 106/L (sensitivity, 71.7%; specificity, 79.5%) and 6.58 pg/mL (77.4%, 74.5%), respectively. There were no statistical differences among all tested indicators of lymphocyte subsets and cytokines between severe group (n = 38) and critical group (n = 15) on hospital admission or ICU admission, respectively. Conclusions The levels of lymphocyte subsets decreased and the level of IL-6 increased significantly in ICU COVID-19 patients compared with non-ICU COVID-19 patients. Therefore, the number of CD3+ T cells and the level of IL-6 on hospital admission may serve as predictive factors for identifying patients with wild-type virus infection who will have severe disease.

Activated CD8+CD38+ Cells Are Associated With Worse Clinical Outcome in Hospitalized COVID-19 Patients

“…It was shown, that selected parameters of immune profile (total number of lymphocytes, CD4 + , CD8 + , CD19 + ) might be used as predictors of severe COVID-19, with AUC values > 0,75 ( 34 , 74 ). In our study, none of examined parameters alone had sufficient sensitivity nor specificity to discriminate between survivors and non-survivors, the highest AUC values were obtained for lymphocyte and neutrophil counts and the total number of CD3 + , CD4 + and CD8 + cells.…”

“…In our study, none of examined parameters alone had sufficient sensitivity nor specificity to discriminate between survivors and non-survivors, the highest AUC values were obtained for lymphocyte and neutrophil counts and the total number of CD3 + , CD4 + and CD8 + cells. However, unlike other studies ( 34 , 74 ), we focused on discrimination between COVID-19 survivors and non-survivors, not severe and non-severe COVID-19 cases. As we have reported, patients with critical (group C) and fatal (group D) disease course did not differ significantly in most examined parameters.…”

Validation of the T-Lymphocyte Subset Index (TLSI) as a Score to Predict Mortality in Unvaccinated Hospitalized COVID-19 Patients

“…Notably, the cutoffs for lymphocyte subset absolute counts identified by our group (CD3+ < 524 cells/μL; CD3+CD4+ < 369 cells/μL; CD3+CD8+ < 194 cells/μL) [ 6 ] were similar to those described by other groups in different settings. Pan P et al found that a value of CD3+ T-cells < 510.5/µL and IL-6 > 6.58 pg/mL were predictors of progression to severe disease in a cohort of COVID-19 patients from China [ 26 ]. Belaid B et al analyzed PB lymphocyte subsets and cytokine levels in 57 COVID-19 patients from North Africa and, using multivariate logistic regression analysis and ROC curves, found that IL-6 > 106.44 pg/mL and CD8+ T-cells < 150/μL were predictive of increased mortality [ 27 ].…”

The risk factors and outcomes for radiological abnormalities in early convalescence of COVID-19 patients caused by the SARS-CoV-2 Omicron variant in Tianjin, China: a retrospective, multicenter follow-up study

“…22,23 Recent data have indicated that the high concentrations of IL-6 in COVID-19 patients due to cytokine storm was related to pulmonary in ammation, extensive lung damage, and even multiple organ failure. 22,24 Moreover, basic researches con rmed the increased serum levels of IL-6 may take part in the induction of lymphopenia through inducing apoptosis in T cells. 21,25 According to the ndings of the previous study, vaccine effectiveness was lower for the Omicron variant than for the delta variant, and the vaccine effectiveness reduced over time from 75.1% after 2 to 4 weeks to 14.9% after 25 or more weeks.…”