Abstract
Background: The clinical characteristics of coronavirus disease 2019 (COVID-19) have been well-studied, while effective predictors for clinical outcome and research on underlying mechanisms are scarce.Methods: Hospitalized COVID-19 pneumonia patients with definitive clinical outcome (cured or died) were retrospectively studied. The diagnostic performance of the leucocyte subsets and other parameters were compared using the area under the receiver operating characteristic curve (AUC). Further, the correlations between leucocyte subsets and inflammation-related factors associated with clinical outcome were subsequently investigated.Results: Among 95 subjects included, 56 patients were cured, and 39 died. Older age, elevated aspartate aminotransferase, total bilirubin, serum lactate dehydrogenase, blood urea nitrogen, prothrombin time, D-dimer, Procalcitonin, and C-reactive protein levels, decreased albumin, elevated serum cytokines (IL2R, IL6, IL8, IL10, and TNF-α) levels, and a decreased lymphocyte count indicated poor outcome in patients with COVID-19 pneumonia. Lymphocyte subset (lymphocytes, T cells, helper T cells, suppressor T cells, natural killer cells, T cells+B cells+NK cells) counts were positively associated with clinical outcome (AUC: 0.777; AUC: 0.925; AUC: 0.900; AUC: 0.902; AUC: 0.877; AUC: 0.918, resp.). The neutrophil-to-lymphocyte ratio (NLR), neutrophil to T lymphocyte count ratio (NTR), neutrophil percentage to T lymphocyte ratio (NpTR) effectively predicted mortality (AUC: 0.900; AUC: 0.905; AUC: 0.932, resp.). Binary logistic regression showed that NpTR was an independent prognostic factor for mortality. Serum IL6 levels were positively correlated with leucocyte count, neutrophil count, and eosinophil count and negatively correlated with lymphocyte count.Conclusion: These results indicate that leucocyte subsets predict the clinical outcome of patients with COVID-19 pneumonia with high efficiency. Non-self-limiting inflammatory response is involved in the development of fatal pneumonia.
Highlights
In December 2019, a new type of β-coronavirus named the 2019 novel coronavirus (SARS-CoV-2) emerged in Wuhan, China, and spread rapidly throughout the world [1]
The leucocyte count or neutrophil count was higher in the died group and predicted the mortality in COVID-19 patients, verified by ROC curves, while lymphocyte subset counts were positively associated with cure rate, among which the area under the ROC curve (AUC) for T cells was the highest (AUC: 0.925, P < 0.001)
ROC curves showed that neutrophil-to-lymphocyte ratio (NLR), NTR, and NpTR could effectively predict the mortality in patients with COVID-19 pneumonia (AUC: 0.900, P < 0.001; AUC: 0.905, P < 0.001; AUC: 0.932, P < 0.001, resp.)
Summary
In December 2019, a new type of β-coronavirus named the 2019 novel coronavirus (SARS-CoV-2) emerged in Wuhan, China, and spread rapidly throughout the world [1]. As of May 31, 2020, 5.9 million cases of coronavirus disease 2019 (COVID19) have been confirmed, including 367 thousand deaths [2]. It was most likely initially a zoonotic infectious disease, but effective transmission between people was soon discovered [3]. Its clinical characteristics have been well-evaluated, but effective predictors for clinical outcome and research on the underlying mechanisms are scarce [6]. The clinical characteristics of coronavirus disease 2019 (COVID-19) have been well-studied, while effective predictors for clinical outcome and research on underlying mechanisms are scarce
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