Abstract
The magnitude of SARS-CoV-2 infection, the dynamic changes of immune parameters in patients with the novel coronavirus disease (COVID-19) and their correlation with the disease severity remain unclear. The clinical and laboratory results from 154 confirmed COVID-19 patients were collected. The SARS-CoV-2 RNA levels in patients were estimated using the Ct values of specific RT-PCR tests. The lymphocyte subsets and cytokine profiles in the peripheral blood were analyzed by flow cytometry and specific immunoassays. 154 confirmed COVID-19 patients were clinically examined up to 4 weeks after admission. The initial SARS-CoV-2 RNA Ct values at admission varied, but were comparable in the patient groups classified according to the age, gender, underlying diseases, and disease severity. Three days after admission, significant higher Ct values were found in severe cases. Significantly reduced counts of T cells and T cell subsets were found in patients with old age and underlying diseases at admission and were characteristic for the development of severe COVID-19. Severe COVID-19 developed preferentially in patients with underlying compromised immunity and was not associated with initial virus levels. Higher SARS-CoV-2 RNA levels in severe cases were apparently a result of impaired immune control associated with dysregulation of inflammation.Electronic supplementary materialThe online version of this article (10.1007/s00430-020-00693-z) contains supplementary material, which is available to authorized users.
Highlights
Reduced counts of T cells and subsets were found in patients with old age and comorbidities at admission and were characteristic of severe COVID-19
Lymphopenia and inflammatory cytokine storm have been found to be associated with the disease severities in highly pathogenic severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) infections [8, 9]
A total of 154 patients were enrolled in this study and were divided into two groups according to the published guidelines, including 122 mild/moderate cases (79.2%, referred to as mild cases thereafter) and 32 severe/critical cases (20.7%, referred to as severe cases)
Summary
Patients with COVID-19 may develop mild or severe symptoms of acute respiratory infection. Some patients develop severe pneumonia, acute respiratory distress syndrome (ARDS) or multiple organ failure, with death rates ranging from 4.3 to 15% according to different study reports [2, 5,6,7]. Lymphopenia and inflammatory cytokine storm have been found to be associated with the disease severities in highly pathogenic severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) infections [8, 9]. A thorough investigation into the dynamic changes in different lymphocyte subsets, the kinetics of inflammatory cytokines changes in the peripheral blood of COVID-19 patients, and the relationships between these parameters and disease severity is still lacking
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