Longitudinal hematologic and immunologic variations associated with the progression of COVID-19 patients in China
Longitudinal hematologic and immunologic variations associated with the progression of COVID-19 patients in China
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DOI：
10.1016/j.jaci.2020.05.003
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发表时间：
2020-07-01
影响因子：
14.2
通讯作者：
Zhong, Nanshan
中科院分区：
文献类型：
--
作者：
Chen, Ruchong;Sang, Ling;Zhong, Nanshan
背景资料：血液学和免疫学反应在冠状病毒疾病进展中的关键作用2019目的：我们试图解决血液学和免疫学生物标志物的动态变化及其与COVID-19严重程度和结果的相关性。方法：进行了一项回顾性研究，包括来自中国国家队列的548名结局明确（出院或死亡）的COVID-19患者。横截面和纵向的变化进行了比较，并与不同的严重程度和outcomes.Results：入院时，淋巴细胞，T细胞亚群，嗜酸性粒细胞，血小板计数显着下降，特别是在严重/危重和致命的患者。中性粒细胞计数和嗜中性粒细胞与淋巴细胞比率升高主要见于重度/危重病例或死亡病例。在住院期间，嗜酸性粒细胞，淋巴细胞，血小板呈上升趋势的幸存者，但维持较低水平或显着下降后，在非幸存者。非幸存者的中性粒细胞、IL-6、前降钙素、D-二聚体、淀粉样蛋白A和C反应蛋白保持较高水平或呈上升趋势，而幸存者则保持稳定或呈下降趋势。存活者CD 8 + T细胞与淋巴细胞计数呈正相关，而死亡者无相关性。多变量考克斯回归模型表明，淋巴细胞，嗜酸性粒细胞和血小板的恢复水平可以作为恢复的预测因子，而中性粒细胞，嗜碱性粒细胞和IL-6的进行性增加与致命outcome.Conclusions：血液学和免疫功能损害显示出不同严重程度的COVID-19患者的幸存者和非幸存者之间的显着不同的配置文件。这些生物标志物的纵向变化可用于预测恢复或致死性结局。
Background: Crucial roles of hematologic and immunologic responses in progression of coronavirus disease 2019 (COVID-19) remain largely unclear.Objective: We sought to address the dynamic changes in hematologic and immunologic biomarkers and their associations with severity and outcomes of COVID-19.Methods: A retrospective study including 548 patients with COVID-19 with clarified outcome (discharged or deceased) from a national cohort in China was performed. Cross-sectional and longitudinal variations were compared and the associations with different severity and outcomes were analyzed.Results: On admission, the counts of lymphocytes, T-cell subsets, eosinophils, and platelets decreased markedly, especially in severe/critical and fatal patients. Increased neutrophil count and neutrophils-to-lymphocytes ratio were predominant in severe/critical cases or nonsurvivors. During hospitalization, eosinophils, lymphocytes, and platelets showed an increasing trend in survivors, but maintained lower levels or dropped significantly afterwards in nonsurvivors. Nonsurvivors kept a high level or showed an upward trend for neutrophils, IL-6, procalcitonin, D-dimer, amyloid A protein, and C-reactive protein, which were kept stable or showed a downward trend in survivors. Positive correlation between CD8(+) T-cell and lymphocytes count was found in survivors but not in nonsurvivors. A multivariate Cox regression model suggested that restored levels of lymphocytes, eosinophils, and platelets could serve as predictors for recovery, whereas progressive increases in neutrophils, basophils, and IL-6 were associated with fatal outcome.Conclusions: Hematologic and immunologic impairment showed a significantly different profile between survivors and nonsurvivors in patients with COVID-19 with different severity. The longitudinal variations in these biomarkers could serve to predict recovery or fatal outcome.