Article: Poor Survival in COVID-19 Associated with Lymphopenia and Higher Neutrophile-Lymphocyte Ratio.
The Israel Medical Association journal : IMAJ
2021 Volume 23, Issue 3, Page(s) 153–159
Abstract: ... μL, B cells CD19+ ≥ 80/μL, and NK ≥ 34/μL subsets were associated with survival in severe COVID-19 ... in severe COVID-19 (odds ratio 11.68).: Conclusions: Total lymphocytes; NLR; and levels of CD3+, CD4+ ... CD8+, and NK cells are useful as biomarkers of survival or mortality in severe COVID-19 disease and ...
| Abstract | Background: Immune cell counts in blood in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection may be useful prognostic biomarkers of disease severity, mortality, and response to treatment. Objectives: To analyze sub-populations of lymphocytes at hospital admission in survivors and deceased from severe pneumonia due to coronavirus disease-2019 (COVID-19). Methods: We conducted a cross-sectional study of healthcare workers confirmed with SARS-CoV-2 in convalescents (control group) and healthy controls (HC) diagnosed with severe COVID-19. Serum samples were taken at hospital admission and after recovery. Serum samples ≥ 25 days after onset of symptoms were analyzed for lymphocyte subpopulations through flow cytometry. Descriptive statistics, Kruskall-Wallis test, receiver operating characteristic curve, calculation of sensitivity, specificity, predictive values, and Kaplan-Meier analysis were performed. Results: We included 337 patients: 120 HC, 127 convalescents, and 90 severe COVID-19 disease patients (50 survivors, 40 deceased). For T cells, total lymphocytes ≥ 800/μL, CD3+ ≥ 400/μL, CD4+ ≥ 180/μL, CD8+ ≥ 150/μL, B cells CD19+ ≥ 80/μL, and NK ≥ 34/μL subsets were associated with survival in severe COVID-19 disease patients. All subtypes of lymphocytes had higher concentrations in survivors than deceased, but similar between HC and convalescents. Leukocytes ≥ 10.150/μL or neutrophils ≥ 10,000/μL were associated with increased mortality. The neutrophil-to-lymphocyte ratio (NLR) ≥ 8.5 increased the probability of death in severe COVID-19 (odds ratio 11.68). Conclusions: Total lymphocytes; NLR; and levels of CD3+, CD4+, CD8+, and NK cells are useful as biomarkers of survival or mortality in severe COVID-19 disease and commonly reach normal levels in convalescents. |
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| MeSH term(s) | Biomarkers/blood ; CD4-Positive T-Lymphocytes/pathology ; CD8-Positive T-Lymphocytes/pathology ; COVID-19/blood ; COVID-19/diagnosis ; COVID-19/mortality ; COVID-19/therapy ; Correlation of Data ; Cross-Sectional Studies ; Female ; Humans ; Kaplan-Meier Estimate ; Killer Cells, Natural/pathology ; Leukocyte Count/methods ; Lymphopenia/blood ; Lymphopenia/diagnosis ; Lymphopenia/etiology ; Male ; Mexico/epidemiology ; Middle Aged ; Mortality ; Neutrophils/pathology ; Predictive Value of Tests ; Symptom Assessment/methods |
| Chemical Substances | Biomarkers |
| Language | English |
| Publishing date | 2021-03-18 |
| Publishing country | Israel |
| Document type | Journal Article |
| ZDB-ID | 2008291-5 |
| ISSN | 1565-1088 ; 0021-2180 |
| ISSN | 1565-1088 ; 0021-2180 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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