tetano
Editor, Senior Moderator
Acute Med Surg
. 2025 Mar 21;12(1):e70044.
doi: 10.1002/ams2.70044. eCollection 2025 Jan-Dec. Early lymphopenia as a predictor of COVID-19 outcomes: A multicenter cohort study
Kazuhiro Okada[SUP] 1 2 [/SUP], Takashi Tagami[SUP] 2 3 4 [/SUP], Takanobu Otaguro[SUP] 5 [/SUP], Mineji Hayakawa[SUP] 6 [/SUP], Kazuma Yamakawa[SUP] 7 [/SUP], Akira Endo[SUP] 8 [/SUP], Takayuki Ogura[SUP] 9 [/SUP], Atsushi Hirayama[SUP] 10 [/SUP], Hideo Yasunaga[SUP] 4 [/SUP], Yoshiaki Hara[SUP] 1 2 [/SUP]
Affiliations
Introduction: Lymphopenia is recognized as a biomarker for predicting outcomes in coronavirus disease (COVID-19). However, the optimal timing for its observation remains uncertain. We investigated the association between early lymphopenia and COVID-19 prognosis, as well as the relationship between lymphocyte count trends and disease outcomes.
Methods: We analyzed data from the J-RECOVER study, a multicenter retrospective cohort study in Japan, encompassing patients with COVID-19 between January and September 2020. The patients were categorized into lymphopenia (LP) (<800 cells/μL) and non-lymphopenia (NL) (≥800 cells/μL) groups based on the lymphocyte counts between days 1 and 4 post-onset. They were further divided into "persistent," "recovered," "exacerbated," and "stable" groups based on lymphocyte counts between days 7 and 10. The primary outcome was the in-hospital mortality. The Cox proportional hazard regression was used for the analysis.
Results: Of 995 enrolled patients, 212 patients (21.3%) were classified into the LP group. LP was significantly associated with in-hospital mortality (hazard ratio
2.32, [95% CI 1.39 to 3.87], p-value 0.001). In both the LP and NL groups, lower lymphocyte counts between 7 and 10 days-categorized as the "persistent" and "exacerbated" groups-was associated with in-hospital mortality (HR 4.65, [95% CI 2.07 to 10.47], p-value <0.001, and HR 5.59, [95% CI 2.24 to 13.97], p-value <0.001, respectively).
Conclusions: Early lymphopenia is predictive of poor prognosis in patients with COVID-19. A declining lymphocyte count trend post-onset further indicates disease deterioration.
Keywords: J‐RECOVER; biomarker; cytokine storm; lymphocyte; prognosis.
. 2025 Mar 21;12(1):e70044.
doi: 10.1002/ams2.70044. eCollection 2025 Jan-Dec. Early lymphopenia as a predictor of COVID-19 outcomes: A multicenter cohort study
Kazuhiro Okada[SUP] 1 2 [/SUP], Takashi Tagami[SUP] 2 3 4 [/SUP], Takanobu Otaguro[SUP] 5 [/SUP], Mineji Hayakawa[SUP] 6 [/SUP], Kazuma Yamakawa[SUP] 7 [/SUP], Akira Endo[SUP] 8 [/SUP], Takayuki Ogura[SUP] 9 [/SUP], Atsushi Hirayama[SUP] 10 [/SUP], Hideo Yasunaga[SUP] 4 [/SUP], Yoshiaki Hara[SUP] 1 2 [/SUP]
Affiliations
- PMID: 40125412
- PMCID: PMC11928683
- DOI: 10.1002/ams2.70044
Introduction: Lymphopenia is recognized as a biomarker for predicting outcomes in coronavirus disease (COVID-19). However, the optimal timing for its observation remains uncertain. We investigated the association between early lymphopenia and COVID-19 prognosis, as well as the relationship between lymphocyte count trends and disease outcomes.
Methods: We analyzed data from the J-RECOVER study, a multicenter retrospective cohort study in Japan, encompassing patients with COVID-19 between January and September 2020. The patients were categorized into lymphopenia (LP) (<800 cells/μL) and non-lymphopenia (NL) (≥800 cells/μL) groups based on the lymphocyte counts between days 1 and 4 post-onset. They were further divided into "persistent," "recovered," "exacerbated," and "stable" groups based on lymphocyte counts between days 7 and 10. The primary outcome was the in-hospital mortality. The Cox proportional hazard regression was used for the analysis.
Results: Of 995 enrolled patients, 212 patients (21.3%) were classified into the LP group. LP was significantly associated with in-hospital mortality (hazard ratio
2.32, [95% CI 1.39 to 3.87], p-value 0.001). In both the LP and NL groups, lower lymphocyte counts between 7 and 10 days-categorized as the "persistent" and "exacerbated" groups-was associated with in-hospital mortality (HR 4.65, [95% CI 2.07 to 10.47], p-value <0.001, and HR 5.59, [95% CI 2.24 to 13.97], p-value <0.001, respectively).
Conclusions: Early lymphopenia is predictive of poor prognosis in patients with COVID-19. A declining lymphocyte count trend post-onset further indicates disease deterioration.
Keywords: J‐RECOVER; biomarker; cytokine storm; lymphocyte; prognosis.