Abstract
Lymphopenia is commonly present in patients with COVID-19. We sought to determine if lymphopenia on admission predicts COVID-19 clinical outcomes. A retrospective chart review was performed on 4485 patients with laboratory-confirmed COVID-19, who were admitted to the hospital. Of those, 2409 (57.3%) patients presented with lymphopenia (absolute lymphocyte count < 1.1 × 109/L) on admission, and had higher incidences of ICU admission (17.9% versus 9.5%, p < 0.001), invasive mechanical ventilation (14.4% versus 6.5%, p < 0.001), dialysis (3.4% versus 1.8%, p < 0.001) and in-hospital mortality (16.6% versus 6.6%, p < 0.001), with multivariable-adjusted odds ratios of 1.86 (95% confidence interval [CI], 1.55–2.25), 2.09 (95% CI, 1.69–2.59), 1.77 (95% CI, 1.19–2.68), and 2.19 (95% CI 1.76–2.72) for the corresponding outcomes, respectively, compared to those without lymphopenia. The restricted cubic spline models showed a non-linear relationship between lymphocyte count and adverse outcomes, with an increase in the risk of adverse outcomes for lower lymphocyte counts in patients with lymphopenia. The predictive powers of lymphopenia, expressed as areas under the receiver operating characteristic curves, were 0.68, 0.69, 0.78, and 0.79 for the corresponding adverse outcomes, respectively, after incorporating age, gender, race, and comorbidities. In conclusion, lymphopenia is a useful metric in prognosticating outcomes in hospitalized COVID-19 patients.
Highlights
The COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), remains a global public healthcare challenge
We investigated the relationship between the continuous changes of absolute lymphocyte count (ALC) on admission and the risk of developing various adverse clinical outcomes such as requirement for admission to the intensive care unit (ICU), use of invasive mechanical ventilation, requirement of dialysis due to acute kidney injury (AKI), and in-hospital mortality in COVID-19 patients
Between 7 March 2020 and 18 January 2021, a total of 4870 adult patients were admitted to the Memorial Healthcare System (MHS) for COVID-19
Summary
The COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), remains a global public healthcare challenge. The clinical course of COVID-19 ranges from asymptomatic disease to critical illness and death [1,2,3,4]. Several inflammatory response markers including procalcitonin, serum ferritin, C-reactive protein (CRP), D-dimer, and interleukin-6 (IL-6), which have been found to correlate significantly with severity of disease and poorer outcomes of COVID-19 patients [8,9]. The use of common clinical characteristics and serum biomarkers has significant limitations in reliably predicting clinical outcomes such as admission intensive care unit (ICU), need for mechanical ventilation, and death in hospitalized COVID-19 patients [10,11]. Given the recurrence of high prevalence SARS-CoV-2 waves in the United
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