Immunological Characteristics of Non-Intensive Care Hospitalized COVID-19 Patients: A Preliminary Report.

Salvatore Corrao,Francesco Gervasi,Francesca Di Bernardo,Giuseppe Natoli,Christiano Argano,Massimo Raspanti,Nicola Catalano

doi:10.3390/jcm10040849

Salvatore Corrao, Francesco Gervasi + Show 5 more

Open Access

https://doi.org/10.3390/jcm10040849

Copy DOI

Abstract

The outbreak of coronavirus disease 2019 (COVID-19) is posing a threat to global health. This disease has different clinical manifestations and different outcomes. The immune response to the novel 2019 coronavirus is complex and involves both innate and adaptive immunity. In this context, cell-mediated immunity plays a vital role in effective immunity against SARS-CoV-2. Significant differences have been observed when comparing severe and non-severe patients. Since these immunological characteristics have not been fully elucidated, we aimed to use cluster analysis to investigate the immune cell patterns in patients with COVID-19 who required hospitalization but not intensive care. We identified four clusters of different immunological patterns, the worst being characterized by total lymphocytes, T helper lymphocytes CD4+ (CD4+), T cytotoxic lymphocytes CD8+ (CD8+) and natural killer (NK) cells below the normal range, together with natural killer lymphocyte granzyme < 50% (NK granzyme+) and antibody-secreting plasma cells (ASCs) equal to 0 with fatal outcomes. In the worst group, 50% of patients died in the intensive care unit. Moreover, a negative trend was found among four groups regarding total lymphocytes, CD4+, CD8+ and B lymphocytes (p < 0.001, p < 0.005, p < 0.000, p < 0.044, respectively). This detailed analysis of immune changes may have prognostic value. It may provide a new perspective for identifying subsets of COVID-19 patients and selecting novel prospective treatment strategies. Notwithstanding these results, this is a preliminary report with a small sample size, and our data may not be generalizable. Further cohort studies with larger samples are necessary to quantify the prognostic value’s weight, according to immunological changes in COVID-19 patients, for predicting prognoses and realizing improvements in clinical conditions.

Highlights

T lymphocytes play a crucial role in an effective response against coronavirus disease 2019 and are mainly damaged by COVID-19 [8]
Chen et al found significant differences between the numbers of CD4+ and CD8+ T cells in severe and moderate cases [6], and Sun et al showed a decrease in the counts of natural killer (NK) cells along with a decline of CD4+ and CD8+ in people with severe disease [11]
The cluster analysis tries to go beyond simple pairs of immune responses and to consider how immunopathological variables tend to occur in conjunction

Summary

Introduction

T lymphocytes play a crucial role in an effective response against coronavirus disease 2019 and are mainly damaged by COVID-19 [8] In this direction, Thevarajan and colleagues showed [9] the decreased function of CD4+ T cells, which may affect patients predisposed to severe disease, and the exhaustion of CD8+ T cells [10], which may reduce the cellular immune response to SARS-CoV-2. Thevarajan and colleagues showed [9] the decreased function of CD4+ T cells, which may affect patients predisposed to severe disease, and the exhaustion of CD8+ T cells [10], which may reduce the cellular immune response to SARS-CoV-2 Further in this regard, Chen et al found significant differences between the numbers of CD4+ and CD8+ T cells in severe and moderate cases [6], and Sun et al showed a decrease in the counts of NK cells along with a decline of CD4+ and CD8+ in people with severe disease [11]. The decrease in the number and dysfunction of CD8+ T cells may lead to a more severe course of illness and a reduction in virus eradication [13]

Objectives

Methods

Conclusion