Clinical and immunologic features in severe and moderate forms of Coronavirus Disease 2019

Abstract

Background Since late December, 2019, an outbreak of pneumonia cases caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, and continued to spread throughout China and across the globe. To date, few data on immunologic features of Coronavirus Disease 2019 (COVID-19) have been reported. Methods In this single-centre retrospective study, a total of 21 patients with pneumonia who were laboratory-confirmed to be infected with SARS-CoV-2 in Wuhan Tongji hospital were included from Dec 19, 2019 to Jan 27, 2020. The immunologic characteristics as well as their clinical, laboratory, radiological features were compared between 11 severe cases and 10 moderate cases. Results Of the 21 patients with COVID-19, only 4 (19%) had a history of exposure to the Huanan seafood market. 7 (33.3%) patients had underlying conditions. The average age of severe and moderate cases was 63.9 and 51.4 years, 10 (90.9%) severe cases and 7 (70.0%) moderate cases were male. Common clinical manifestations including fever (100%, 100%), cough (70%, 90%), fatigue (100%, 70%) and myalgia (50%, 30%) in severe cases and moderate cases. PaO2/FiO2 ratio was significantly lower in severe cases (122.9) than moderate cases (366.2). Lymphocyte counts were significantly lower in severe cases (7000 million/L) than moderate cases (11000 million/L). Alanine aminotransferase, lactate dehydrogenase levels, high-sensitivity C-reactive protein and ferritin were significantly higher in severe cases (41.4 U/L, 567.2 U/L, 135.2 mg/L and 1734.4 ug/L) than moderate cases (17.6 U/L, 234.4 U/L, 51.4 mg/L and 880.2 ug /L). IL-2R, TNF-α and IL-10 concentrations on admission were significantly higher in severe cases (1202.4 pg/mL, 10.9 pg/mL and 10.9 pg/mL) than moderate cases (441.7 pg/mL, 7.5 pg/mL and 6.6 pg/mL). Absolute number of total T lymphocytes, CD4+T cells and CD8+T cells decreased in nearly all the patients, and were significantly lower in severe cases (332.5, 185.6 and 124.3 million/L) than moderate cases (676.5, 359.2 and 272.0 million/L). The expressions of IFN-γ by CD4+T cells tended to be lower in severe cases (14.6%) than moderate cases (23.6%). Conclusion The SARS-CoV-2 infection may affect primarily T lymphocytes, particularly CD4+T cells, resulting in significant decrease in number as well as IFN-γ production, which may be associated with disease severity. Together with clinical characteristics, early immunologic indicators including diminished T lymphocytes and elevated cytokines may serve as potential markers for prognosis in COVID-19.

Potential Factors for Prediction of Disease Severity of COVID-19 Patients

“…Consistent with previous study [20] , we also observed the decreased absolute number of CD3 + T cells in severe and mild patients (85.7%vs51.7%); moreover, the number of both CD4 + and CD8 + T cells were markedly lower in severe patients than mild patients. So far, the All rights reserved.…”

Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients

“…in the pathological process of COVID-19 . 10 We also found that the development of lymphopenia in severe patients was mainly related to the significantly decreased absolute counts of T cells, especially CD8 + T cells, but not to the absolute counts of B cells and NK cells. The decrease of T cells in the severe patient group reached its peak within the first week during the disease course, and then T cell numbers gradually increased during the second week and recovered to a comparable level to that of the mild patient group in the third week.…”

“…IL-6) in COVID-19 patients. 5,[8][9][10] However, it has remained largely unclear in the kinetics of lymphocyte subsets and inflammatory cytokines change in the peripheral blood during COVID-19. In this study, we longitudinally characterized the changes of lymphocyte subsets and cytokines profiles in the peripheral blood of COVID-19 patients with distinct disease severities.…”

Targeting the catecholamine-cytokine axis to prevent SARS-CoV-2 cytokine storm syndrome

“…Emerging evidence suggests that a subset of COVID-19 is characterized by the development of a cytokine storm syndrome (CSS) that resembles cytokine release syndrome (CRS) in chimeric antigen receptor (CAR)-T cell therapy (2,4,5). Hyperinflammation in COVID-19 is associated with elevation of pro-inflammatory cytokines including interleukin (IL)-6, IL-2R, IL-8, tumor necrosis factor-α, and granulocyte-colony stimulating factor (4,6), similar to the exuberant cytokine production by lunginfiltrating monocytes/macrophages and pneumocytes observed in SARS-CoV-1 and MERS-CoV infection (7). Alveolar inflammation and diffuse alveolar damage impair the infected lungs' local ability to participate in gas exchange, culminating in ARDS and necessitating mechanical ventilation (8).…”