Clinical characteristics and peripheral immunocyte subsets alteration of 85 COVID-19 deaths

Abstract

Objectives: To retrospectively evaluate the clinical and immunological characteristics of patients who died of COVID-19 and to identify patients at high risk of death at an early stage and reduce their mortality. Results: Total white blood cell count, neutrophil count and C-reactive protein were significantly higher in patients who died of COVID-19 than those who recovered from it (p < 0.05), but the total lymphocyte count, CD4 + T cells, CD8 + T cells, B cells and natural killer cells were significantly lower when compared in the same groups. Multiple logistic regression analysis showed that increased D-dimer, decreased CD4 + T cells and increased neutrophils were risk factors for mortality. Further multiple COX regression demonstrated that neutrophil ≥ 5.27 × 109/L increased the risk of death in COVID-19 patients after adjustment for age and gender. However, CD4 + T cells ≥ 260/μL appeared to reduce the risk of death. Conclusion: SARS-CoV-2 infection led to a significant decrease of lymphocytes, and decreased CD4 + T cell count was a risk factor for COVID-19 patients to develop severe disease and death. Methods: This study included 190 hospitalized COVID-19 patients from January 30, 2020 to March 4, 2020 in Wuhan, China, of whom 85 died and 105 recovered. Two researchers independently collected the clinical and laboratory data from electronic medical records.

The value of early positive nucleic acid test and negative conversion time of SARS-CoV-2 RNA in the clinical outcome of COVID-19 patients

“…The condition of severe patients with COVID-19 is critical and can change rapidly (23). Our results demonstrated that the white blood cell count, neutrophil count, and lymphocyte count were signi cantly lower in the severe group than in the mild group, suggesting that early diagnosis and intervention are very important to reduce the risk of death caused by the tendency to severe condition transformation (24). A study comparing the virus shedding time between patients hospitalized in ICU and those not hospitalized in ICU, showed that the duration of virus shedding time of blood, saliva, and nasal samples was longer in ICU patients than in non-ICU patients (25).…”

The Value of Early Positive Nucleic Acid Test and Negative Conversion Time of SARS-CoV-2 RNA in the Clinical Outcome of COVID-19 Patients

“…The condition of severe patients with COVID-19 is critical and can change rapidly. Our results demonstrated that the white blood cell count, neutrophil count, and lymphocyte count were significantly lower in the severe group than in the mild group, suggesting that early diagnosis and intervention are very important to reduce the risk of death caused by the tendency to severe condition transformation ( 26 ). A study comparing the virus shedding time between patients hospitalized in the ICU and those not hospitalized in the ICU showed that the duration of virus shedding time of blood, saliva, and nasal samples was longer in ICU patients than in non-ICU patients ( 27 ).…”

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

“…Focusing on T-cell subsets, several studies have highlighted the role of T-lymphocyte subset absolute counts assessed at hospitalization in predicting the risk of death in COVID-19 patients. Xiong L. et al evaluated lymphocyte subsets in 85 COVID-19 fatal cases and found that an increase in neutrophils absolute count and a decrease in CD4+ T-cell absolute count were independent risk factors for mortality [ 22 ]. Overall, in our population, median CD3+, CD3+CD4+, and CD3+CD8+ T-lymphocyte absolute counts were reduced, while CD19+ B-lymphocyte and CD3negCD16+CD56+ NK-cell absolute counts were within laboratory normality ranges.…”