Abstract
Background and Aim: Lymphocytes play an important role in fighting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Low total lymphocyte count (TLC), which contributes to poor clinical outcomes, is common in persons with coronavirus disease 2019 (COVID-19). The current explanation for the cause of low TLC is that it is directly related to the invasiveness of SARS-CoV-2, which attacks lymphocytes. We hypothesized that malnutrition contributes to the development of low TLC in early-stage COVID-19.Methods: We prospectively enrolled 101 patients with confirmed COVID-19. On their first day of hospitalization, we collected baseline and laboratory data, including clinical symptoms; the Sequential Organ Failure Assessment, Nutrition Risk Screening 2002 and Subjective Global Assessment were used to assess the malnutrition status of the patients. Multivariable logistic regression was used to identify independent risk factors for low TLC and severe COVID-19.Results: Malnutrition was associated with lower TLC in COVID-19. Fifty-nine (58.4%) of the patients showed low TLC, 41 (40.6%) were at risk for malnutrition, and 18 of them were malnourished. Low TLC was an independent risk factor for severe COVID-19. Compared to patients with normal TLC, those with low TLC more often presented with anorexia, malnutrition, higher SOFA scores (P < 0.05) and comorbidities (diabetes and malignancies). Malnutrition (OR: 3.05, 95% CI: 1.5–6.19, P = 0.006) and SOFA scores (OR: 1.51, 95% CI: 1.04-2.43, P = 0.042) were identified as independent risk factors for low TLC.Conclusions: Malnutrition was common among our patients with early-stage COVID-19, and it contributed to the occurrence of low TLC.
Highlights
Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues its rapid spread globally
Years Sex Male Female Lymphocyte count, ×109/L Comorbidities Hypertension Cardiovascular disease Diabetes Cerebrovascular disease Chronic obstructive pulmonary disease Chronic liver disease Chronic kidney disease Comorbidities related to lymphopenia Malignancy Lupus Rheumatoid arthritis Othersa Clinical symptoms Fever Cough Dyspnea Anorexia Diarrhea Vomiting Use of drug that may induce lymphopenia within 2 weeks before hospitalization Corticosteroid Thymic hormones Cytotoxic drugs Interferon Othersb Malnutrition status 1 No risk for malnutrition 2 Risk for malnutrition 3Malnourished SOFA score Outcomes Severe COVID-19 acute respiratory distress syndrome (ARDS) Intensive care unit (ICU) care Death
The cut-off point for low total lymphocyte count (TLC) and normal TLC is 1.1 × 109/l. a. including aplastic anemia, human immunodeficiency virus (HIV), hypersplenism, myelodysplastic syndrome, and tuberculosis. b. including monoclonal antibodies, cimetidine, and opioids
Summary
Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues its rapid spread globally. A lymphocyte is a type of immune cell that plays an important role in fighting SARS-CoV2 infection, and low total lymphocyte count (TLC) is common in COVID-19, ranging from 35 to 82% of patients [1, 2]. We aimed to establish a multivariable model and determine whether malnutrition is an independent risk factor for low TLC in COVID-19. Another goal of this study was to produce evidence for the pathogenesis of lymphopenia in early-stage COVID-19 and demonstrate the feasibility of elevating TLC levels through nutrition management as a treatment for affected patients. Low total lymphocyte count (TLC), which contributes to poor clinical outcomes, is common in persons with coronavirus disease 2019 (COVID-19). We hypothesized that malnutrition contributes to the development of low TLC in early-stage COVID-19
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