Association of Clinical and Immunological Characteristics With Disease Severity and Outcomes in 211 Patients With COVID-19 in Wuhan, China.

Man Wang,Wenlin Cheng,Yuqiong Chai,Xiaorong Hu,Yongzhen Fan,Jianlei Cao,Kun Wang

doi:10.3389/fcimb.2021.667487

Abstract

BackgroundCoronavirus disease 2019 (COVID-19) has posed a great threat to global public health. There remains an urgent need to address the clinical significance of laboratory finding changes in predicting disease progression in COVID-19 patients. We aimed to analyze the clinical and immunological features of severe and critically severe patients with COVID-19 in comparison with non-severe patients and identify risk factors for disease severity and clinical outcome in COVID-19 patients.MethodsThe consecutive records of 211 patients with COVID-19 who were admitted to Zhongnan Hospital of Wuhan University from December 2019 to February 2020 were retrospectively reviewed.ResultsOf the 211 patients with COVID-19 recruited, 111 patients were classified as non-severe, 59 as severe, and 41 as critically severe cases. The median age was obviously higher in severe and critically severe cases than in non-severe cases. Severe and critically severe patients showed more underlying comorbidities than non-severe patients. Fever was the predominant presenting symptom in COVID-19 patients, and the duration of fever was longer in critically severe patients. Moreover, patients with increased levels of serum aminotransferases and creatinine (CREA) were at a higher risk for severe and critical COVID-19 presentations. The serum levels of IL-6 in severe and critically severe patients were remarkably higher than in non-severe patients. Lymphopenia was more pronounced in severe and critically severe patients compared with non-severe patients. Lymphocyte subset analysis indicated that severe and critically severe patients had significantly decreased count of lymphocyte subpopulations, such as CD4+ T cells, CD8+ T cells and B cells. A multivariate logistic analysis indicated that older age, male sex, the length of hospital stay, body temperature before admission, comorbidities, higher white blood cell (WBC) counts, lower lymphocyte counts, and increased levels of IL-6 were significantly associated with predicting the progression to severe stage of COVID-19.ConclusionOlder age, male sex, underlying illness, sustained fever status, abnormal liver and renal functions, excessive expression of IL-6, lymphopenia, and selective loss of peripheral lymphocyte subsets were related to disease deterioration and clinical outcome in COVID-19 patients. This study would provide clinicians with valuable information for risk evaluation and effective interventions for COVID-19.

Highlights

In December 2019, an outbreak of viral pneumonia, known as coronavirus disease 2019 (COVID-19), was reported in Wuhan, Hubei Province, China (Huang et al, 2020)
The clinical features of COVID-19 patients enrolled in this study were comparable with those of previous studies
The patients with COVID-19 in the severe and critically severe groups were of old age and had underlying comorbidities

Summary

Introduction

In December 2019, an outbreak of viral pneumonia, known as coronavirus disease 2019 (COVID-19), was reported in Wuhan, Hubei Province, China (Huang et al, 2020). The etiological agent of COVID-19 was quickly identified as a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is phylogenetically close to SARS-CoV (Zhou et al, 2020; Zhu et al, 2020). SARS-CoV-2 is regarded as the third highly pathogenic human coronavirus of the 21st century (Hu et al, 2020). SARS-CoV-2-infected patients, including asymptomatic carriers, are the primary source of infection (Rothe et al, 2020). The incubation period of COVID-19 ranges from 1 to 14 days and is commonly 3-7 days; it is difficult to identify infected patients in the early stage (Backer et al, 2020). Coronavirus disease 2019 (COVID-19) has posed a great threat to global public health. There remains an urgent need to address the clinical significance of laboratory finding changes in predicting disease progression in COVID-19 patients. We aimed to analyze the clinical and immunological features of severe and critically severe patients with COVID-19 in comparison with non-severe patients and identify risk factors for disease severity and clinical outcome in COVID-19 patients

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