Abstract
Objectives: A decrease in blood cell counts, especially lymphocytes and eosinophils, has been described in patients with severe SARS-CoV-2 (COVID-19), but there is no knowledge of the potential role of their recovery in these patients’ prognosis. This article aims to analyse the effect of blood cell depletion and blood cell recovery on mortality due to COVID-19. Design: This work is a multicentre, retrospective, cohort study of 9,644 hospitalised patients with confirmed COVID-19 from the Spanish Society of Internal Medicine’s SEMI-COVID-19 Registry. Setting: This study examined patients hospitalised in 147 hospitals throughout Spain. Participants: This work analysed 9,644 patients (57.12% male) out of a cohort of 12,826 patients ≥18 years of age hospitalised with COVID-19 in Spain included in the SEMI-COVID-19 Registry as of 29 May 2020. Main outcome measures: The main outcome measure of this work is the effect of blood cell depletion and blood cell recovery on mortality due to COVID-19. Univariate analysis was performed to determine possible predictors of death and then multivariate analysis was carried out to control for potential confounders. Results: An increase in the eosinophil count on the seventh day of hospitalisation was associated with a better prognosis, including lower mortality rates (5.2% vs 22.6% in non-recoverers, OR 0.234 [95% CI, 0.154 to 0.354]) and lower complication rates, especially regarding to development of acute respiratory distress syndrome (8% vs 20.1%, p=0.000) and ICU admission (5.4% vs 10.8%, p=0.000). Lymphocyte recovery was found to have no effect on prognosis. Treatment with inhaled or systemic glucocorticoids was not found to be a confounding factor. Conclusion: Eosinophil recovery in patients with COVID-19 is a reliable marker of a good prognosis that is independent of prior treatment. This finding could be used to guide discharge decisions.Funding Statement: None.Declaration of Interests: The authors declare that there are no conflicts of interest.Ethics Approval Statement: Data confidentiality and patient anonymity were maintained at all times, in accordance with Spanish regulations on observational studies. This study was carried out in accordance with the Declaration of Helsinki and was approved by the Institutional Research Ethics Committees of each participating hospital.
Highlights
In December 2019, a pneumonia of unknown origin was described in the city of Wuhan, the capital of Hubei province in China, caused by a novel coronavirus that was later named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) [1]
Our study shows that eosinophil recovery has a positive prognostic impact in COVID-19 that is independent of previous lymphocyte or eosinophil levels and previous use of systemic or inhaled corticosteroids
The first descriptions of eosinophil depletion came from small series [16,18], and eosinopenia upon admission was proposed as a reliable early diagnostic marker for SARS-COV-2 infection [12,13,14]
Summary
In December 2019, a pneumonia of unknown origin was described in the city of Wuhan, the capital of Hubei province in China, caused by a novel coronavirus that was later named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) [1]. The infection was named COVID-19 (coronavirus disease 2019) in February [2], and later labelled a pandemic [3]. As of 6 December 2020, nearly 66 million COVID-19 cases had been confirmed, and 1,523,656 patients had died. Great effort has been made in describing the clinical and epidemiological features of COVID-19 [5,6,7], less is known about prognostic factors [8,9,10]. Some prognostic factors upon admission are lymphopenia and high levels of D-dimer (DD), lactate dehydrogenase (LDH), and C-reactive protein (CRP) [8,9,12]
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