Differences of blood cells, lymphocyte subsets and cytokines in COVID-19 patients with different clinical stages: a network meta-analysis

Wu Yan,Francis Manyori Bigambo,Danrong Chen,Xu Wang,Yankai Xia,Hongcheng Wei

doi:10.1186/s12879-021-05847-9

Abstract

BackgroundDue to the rapid spread of coronavirus disease 2019 (COVID-19) worldwide, it is necessary to ascertain essential immune inflammatory parameters that describe the severity of the disease and provide guidance for treatment. We performed network meta-analyses to determine differences in blood cells, lymphocyte subsets, and cytokines in COVID-19 patients with different clinical stages.MethodsDatabases were systematically searched to May 2, 2020, and updated on June 1, 2020. Network meta-analyses were conducted via Stata 15.0, and the mean difference (MD) and its 95% CI were used as the effect values of the pooled analysis.ResultsSeventy-one studies were included involving 8647 COVID-19 patients, White blood cell (WBC), neutrophil (NEUT), IL-6, and IL-10 counts increased significantly with worsening of the COVID-19, while lymphocyte (LYM) counts decreased. The levels of platelet (PLT), CD3+, CD4+, CD8+, and CD19+ cells in severe and critical patients were significantly lower than those in mild patients. IL-1β count was significantly elevated in critical patients.ConclusionsImmune suppression and inflammatory injury play crucial roles in the progression of COVID-19, and the identification of susceptible cells and cytokines provide guidance for the early and accurate treatment of COVID-19 patients.

Highlights

Due to the rapid spread of coronavirus disease 2019 (COVID-19) worldwide, it is necessary to ascertain essential immune inflammatory parameters that describe the severity of the disease and provide guidance for treatment
In the network meta-analysis, we classified COVID-19 patients into mild, severe, and critical groups based on the severity of the disease
In the network meta-analysis, we found that the White blood cell (WBC) counts in the severe group (MD = 1.10, 95% CI: 0.68 to 1.53) and the critical group (MD = 2.26, 95% CI: 1.57 to 2.95) were significantly higher than those in the mild group

Summary

Introduction

Due to the rapid spread of coronavirus disease 2019 (COVID-19) worldwide, it is necessary to ascertain essential immune inflammatory parameters that describe the severity of the disease and provide guidance for treatment. The patients with COVID-19 were classified into four groups based on the New Coronavirus Pneumonia Prevention and Control Program [2]: mild cases with mild clinical symptoms, and no pneumonia manifestation on imaging; moderate cases with any of fever, respiratory tract symptoms, and pneumonia manifestations in imaging; severe cases with respiratory rate ≥ 30 breath per minute, oxygen saturation ≤ 93% at rest state, arterial partial pressure of oxygen (PaO2)/ Oxygen concentration (FiO2) ≤ 300 mmHg and lung lesions progression > 50% manifestations in imaging within 24 to 48 h; and critical cases with any of respiratory failure requiring mechanical ventilation, shock, multiple organ failure requiring intensive care unit (ICU) treatment These symptoms caused by COVID-19 infection were related to sustained responses of cytokines and chemokines (known as cytokine storm), which increased the incidence of immunity disorders and mortality [3]. Continuous stimulation by the virus may cause T cells exhaustion a condition that may lead to a loss in cytokine production and decline in functions [10, 11] and multiple organ dysfunction [12]

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