Definition of the Immune Parameters Related to COVID-19 Severity

Abstract

A relevant portion of patients with disease caused by the severe acute respiratory syndrome coronavirus 2 (COVID-19) experience negative outcome, and several laboratory tests have been proposed to predict disease severity. Among others, dramatic changes in peripheral blood cells have been described. We developed and validated a laboratory score solely based on blood cell parameters to predict survival in hospitalized COVID-19 patients. We retrospectively analyzed 1,619 blood cell count from 226 consecutively hospitalized COVID-19 patients to select parameters for inclusion in a laboratory score predicting severity of disease and survival. The score was derived from lymphocyte- and granulocyte-associated parameters and validated on a separate cohort of 140 consecutive COVID-19 patients. Using ROC curve analysis, a best cutoff for score of 30.6 was derived, which was associated to an overall 82.0% sensitivity (95% CI: 78–84) and 82.5% specificity (95% CI: 80–84) for detecting outcome. The scoring trend effectively separated survivor and non-survivor groups, starting 2 weeks before the end of the hospitalization period. Patients’ score time points were also classified into mild, moderate, severe, and critical according to the symptomatic oxygen therapy administered. Fluctuations of the score should be recorded to highlight a favorable or unfortunate trend of the disease. The predictive score was found to reflect and anticipate the disease gravity, defined by the type of the oxygen support used, giving a proof of its clinical relevance. It offers a fast and reliable tool for supporting clinical decisions and, most important, triage in terms of not only prioritization but also allocation of limited medical resources, especially in the period when therapies are still symptomatic and many are under development. In fact, a prolonged and progressive increase of the score can suggest impaired chances of survival and/or an urgent need for intensive care unit admission.

Lymphocyte and neutrophil count combined with intestinal bacteria abundance predict the severity of COVID-19

“…Using lymphocyte and granulocyte-related parameters to build the model can well predict the disease severity and survival of COVID-19 patients. With the optimal cut-off score of 30.6 obtained by ROC curve, the sensitivity and specificity of detection were 82.0% and 82.5%, respectively ( 39 ).…”

Peripheral blood parameters for predicting PICU admission and mechanical ventilation in pediatric inpatients with human parainfluenza virus‐induced pneumonia

“…Thus, both the increased levels of L depletion and marked perturbations in L subset composition might be important factors leading to exacerbations of patients, while the recovery of L numbers helped to alleviate the severity of disease 36 . Likewise, it has been reported that a laboratory score derived from lymphocyte‐ and granulocyte‐associated parameters reflected and anticipated the disease gravity, urgent need for ICU admission, and chances of survival of hospitalized SARS‐COV‐2 patients 37 . LDC‐related parameters expands clinicians' ability to personalize risk assessment and management opinions for patients.…”

“…36 Likewise, it has been reported that a laboratory score derived from lymphocyte-and granulocyte-associated parameters reflected and anticipated the disease gravity, urgent need for ICU admission, and chances of survival of hospitalized SARS-COV-2 patients. 37 LDC-related parameters expands clinicians' ability to personalize risk assessment and management opinions for patients. During the early stage of viral infection, depletion efficiencies of some proteins increased via participating in antiviral response against viral invasion and replication, whereas levels of some acute phase proteins in plasma such as CRP, might be elevated.…”

T Cells Immunophenotyping and CD38 Overexpression as Hallmarks of the Severity of COVID-19 and Predictors of Patients’ Outcomes

“…Globally, as of September 2022, there were 613 million confirmed COVID-19 cases, resulting in 6.5 million deaths, reported to the World Health Organization (WHO) [ 1 ]. To properly manage the hospitalization of COVID-19 patients, it became obvious that the methods to assess the severity and outcome of the disease, such as the distribution of cell types and the viral infection in peripheral blood, were very important [ 2 ].…”