Immune Phenotyping Based on the Neutrophil-to-Lymphocyte Ratio and IgG Level Predicts Disease Severity and Outcome for Patients With COVID-19.

Bicheng Zhang,Fan Feng,Xiaoyang Zhou,Jia Feng,Jun Wang,Chengliang Zhu,Yanru Qiu,Yuxiao Song,Qibin Song,Qingzhu Jia,Bo Zhu

doi:10.3389/fmolb.2020.00157

Abstract

Introduction: A recently emerging respiratory disease named coronavirus disease 2019 (COVID-19) has quickly spread across the world. This disease is initiated by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and uncontrolled cytokine storm, but it remains unknown as to whether a robust antibody response is related to clinical deterioration and poor outcome in COVID-19 patients.Methods: Anti-SARS-CoV-2 IgG and IgM antibodies were determined by chemiluminescence analysis (CLIA) in COVID-19 patients at a single center in Wuhan. Median IgG and IgM levels in acute and convalescent-phase sera (within 35 days) for all included patients were calculated and compared between severe and non-severe patients. Immune response phenotyping based on the late IgG levels and neutrophil-to-lymphocyte ratio (NLR) was characterized to stratified patients into different disease severities and outcomes.Results: A total of 222 patients were included in this study. IgG was first detected on day 4 of illness, and its peak levels occurred in the fourth week. Severe cases were more frequently found in patients with high IgG levels, compared to those with low IgG levels (51.8 vs. 32.3%; p = 0.008). Severity rates for patients with NLRhiIgGhi, NLRhiIgGlo, NLRloIgGhi, and NLRloIgGlo phenotype were 72.3, 48.5, 33.3, and 15.6%, respectively (p < 0.0001). Furthermore, severe patients with NLRhiIgGhi, NLRhiIgGlo had higher inflammatory cytokines levels including IL-2, IL-6 and IL-10, and decreased CD4+ T cell count compared to those with NLRloIgGlo phenotype (p < 0.05). Recovery rates for severe patients with NLRhiIgGhi, NLRhiIgGlo, NLRloIgGhi, and NLRloIgGlo phenotype were 58.8% (20/34), 68.8% (11/16), 80.0% (4/5), and 100% (12/12), respectively (p = 0.0592). Dead cases only occurred in NLRhiIgGhi and NLRhiIgGlo phenotypes.Conclusions: COVID-19 severity is associated with increased IgG response, and an immune response phenotyping based on the late IgG response and NLR could act as a simple complementary tool to discriminate between severe and non-severe COVID-19 patients, and further predict their clinical outcome.

Highlights

A recently emerging respiratory disease named coronavirus disease 2019 (COVID-19) has quickly spread across the world
Severe cases were more frequently found in patients with high IgG levels (≥116.9 AU/mL), compared to those with low IgG levels (
IgG levels increased at late stage, whereas high levels of IgG were frequently found in patients with severe disease

Summary

Introduction

A recently emerging respiratory disease named coronavirus disease 2019 (COVID-19) has quickly spread across the world This disease is initiated by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and uncontrolled cytokine storm, but it remains unknown as to whether a robust antibody response is related to clinical deterioration and poor outcome in COVID-19 patients. Since December 2019, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has quickly spread across the world (Wu et al, 2020). Organ dysfunction including acute respiratory distress syndrome, shock, acute cardiac injury, and acute renal injury, could occur in severe cases with COVID-19, which lead to poor clinical outcome (Huang et al, 2020; Wang et al, 2020). The dynamic of anti-SARS-CoV-2 antibody upon virus infection and their relation to disease status and outcome remain to be determined (Liu et al, 2020a)

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Results

Conclusion