Overall reduced lymphocyte especially T and B subsets closely related to the poor prognosis and the disease severity in severe patients with COVID-19 and diabetes mellitus

Dafeng Liu,Hong Chen,Lei Bao,Qingfeng Li,Yilan Zeng,Yong Wang,Min Yang,Bennan Zhao,Yaling Liu,Lijuan Lan

doi:10.1186/s13098-020-00622-3

Dafeng Liu, Hong Chen + Show 8 more

Open Access

https://doi.org/10.1186/s13098-020-00622-3

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Abstract

BackgroundA dysregulated host immune response is common in patients with COVID-19.AimIn this study, we aimed to define the characteristics of lymphocyte subsets and their relationship with disease progression in COVID-19 patients with or without diabetes mellitus (DM).MethodsThe baseline peripheral lymphocyte subsets were compared between 55 healthy controls and 95 patients with confirmed COVID-19, and between severe and non-severe COVID-19 patients with or without DM.ResultsThe prevalence of DM in the COVID-19 group was 20%, and patients with severe COVID-19 had a higher prevalence of DM than those with non-severe disease (P = 0.006). Moreover, a significantly poor prognosis and a higher rate of severity were found in those with DM relative to those without DM (P = 0.001, 0.003). Generally, all lymphocytes and subsets of lymphocytes, especially B and T cells, were significant reduced in COVID-19 patients, particularly in those with DM. Patients with severe COVID-19 and DM had the lowest lymphocyte counts compared with those with severe COVID-19 without DM, and those with non-severe COVID-19 with or without DM. Partially decreased lymphocyte subsets, age and DM were closely related to disease progression and prognosis.ConclusionsThese findings provide a reference for clinicians that immunomodulatory treatment may improve disease progression and prognosis of COVID-19 patients, especially those with severe disease with DM.Trial registration Chinese Clinical Trial Register ChiCTR2000034563

Highlights

Despite the worldwide pandemic [1,2,3,4,5,6], most patients with coronavirus disease 2019 (COVID-19) have a good prognosis, but some patients with rapid disease progression have a poor prognosis [7,8,9,10,11]
These findings provide a reference for clinicians that immunomodulatory treatment may improve disease progression and prognosis of COVID-19 patients, especially those with severe disease with diabetes mellitus (DM)
We found that lymphocytes and lymphocyte subsets were negatively correlated with disease severity, and that lymphocytes were negatively correlated with prognosis

Summary

Introduction

Despite the worldwide pandemic [1,2,3,4,5,6], most patients with coronavirus disease 2019 (COVID-19) have a good prognosis, but some patients with rapid disease progression have a poor prognosis [7,8,9,10,11]. Dysregulation of the host immune response, especially reduced cellular immunity, plays an important role in the. Liu et al Diabetol Metab Syndr (2021) 13:5 pathophysiology of COVID-19 [8, 13, 14], SARS [15], and MERS-CoV [16]. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can alter both the innate and adaptive immune responses [17]. Reduced CD3+, CD4+, and CD8+ T lymphocyte counts may reflect the severity of COVID-19 [18]. DM could lead to dysfunctional cellular immunity [19], and DM was shown to be an independent risk factor for the prognosis of COVID-19 [20]. A dysregulated host immune response is common in patients with COVID-19

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