tetano
Editor, Senior Moderator
Isr Med Assoc J
. 2021 Mar;23(3):153-159.
Poor Survival in COVID-19 Associated with Lymphopenia and Higher Neutrophile-Lymphocyte Ratio
Laura A Montiel-Cervantes[SUP] 1 2 [/SUP], Gabriela Medina[SUP] 1 [/SUP], Maria Pilar Cruz-Dom?nguez[SUP] 3 [/SUP], Sonia-Mayra P?rez-Tapia[SUP] 4 5 6 [/SUP], Maria C Jim?nez-Mart?nez[SUP] 7 [/SUP], Hugo-Iv?n Arrieta-Oliva[SUP] 4 6 [/SUP], Gregorio Carballo-Uicab[SUP] 4 6 [/SUP], Laura L?pez-Pelcastre[SUP] 8 [/SUP], Rosa Camacho-Sandoval[SUP] 4 6 [/SUP]
Affiliations
Abstract
Background: Immune cell counts in blood in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection may be useful prognostic biomarkers of disease severity, mortality, and response to treatment.
Objectives: To analyze sub-populations of lymphocytes at hospital admission in survivors and deceased from severe pneumonia due to coronavirus disease-2019 (COVID-19).
Methods: We conducted a cross-sectional study of healthcare workers confirmed with SARS-CoV-2 in convalescents (control group) and healthy controls (HC) diagnosed with severe COVID-19. Serum samples were taken at hospital admission and after recovery. Serum samples ? 25 days after onset of symptoms were analyzed for lymphocyte subpopulations through flow cytometry. Descriptive statistics, Kruskall-Wallis test, receiver operating characteristic curve, calculation of sensitivity, specificity, predictive values, and Kaplan-Meier analysis were performed.
Results: We included 337 patients: 120 HC, 127 convalescents, and 90 severe COVID-19 disease patients (50 survivors, 40 deceased). For T cells, total lymphocytes ? 800/?L, CD3+ ? 400/?L, CD4+ ? 180/?L, CD8+ ? 150/?L, B cells CD19+ ? 80/?L, and NK ? 34/?L subsets were associated with survival in severe COVID-19 disease patients. All subtypes of lymphocytes had higher concentrations in survivors than deceased, but similar between HC and convalescents. Leukocytes ? 10.150/?L or neutrophils ? 10,000/?L were associated with increased mortality. The neutrophil-to-lymphocyte ratio (NLR) ? 8.5 increased the probability of death in severe COVID-19 (odds ratio 11.68).
Conclusions: Total lymphocytes; NLR; and levels of CD3+, CD4+, CD8+, and NK cells are useful as biomarkers of survival or mortality in severe COVID-19 disease and commonly reach normal levels in convalescents.
. 2021 Mar;23(3):153-159.
Poor Survival in COVID-19 Associated with Lymphopenia and Higher Neutrophile-Lymphocyte Ratio
Laura A Montiel-Cervantes[SUP] 1 2 [/SUP], Gabriela Medina[SUP] 1 [/SUP], Maria Pilar Cruz-Dom?nguez[SUP] 3 [/SUP], Sonia-Mayra P?rez-Tapia[SUP] 4 5 6 [/SUP], Maria C Jim?nez-Mart?nez[SUP] 7 [/SUP], Hugo-Iv?n Arrieta-Oliva[SUP] 4 6 [/SUP], Gregorio Carballo-Uicab[SUP] 4 6 [/SUP], Laura L?pez-Pelcastre[SUP] 8 [/SUP], Rosa Camacho-Sandoval[SUP] 4 6 [/SUP]
Affiliations
- PMID: 33734627
Abstract
Background: Immune cell counts in blood in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection may be useful prognostic biomarkers of disease severity, mortality, and response to treatment.
Objectives: To analyze sub-populations of lymphocytes at hospital admission in survivors and deceased from severe pneumonia due to coronavirus disease-2019 (COVID-19).
Methods: We conducted a cross-sectional study of healthcare workers confirmed with SARS-CoV-2 in convalescents (control group) and healthy controls (HC) diagnosed with severe COVID-19. Serum samples were taken at hospital admission and after recovery. Serum samples ? 25 days after onset of symptoms were analyzed for lymphocyte subpopulations through flow cytometry. Descriptive statistics, Kruskall-Wallis test, receiver operating characteristic curve, calculation of sensitivity, specificity, predictive values, and Kaplan-Meier analysis were performed.
Results: We included 337 patients: 120 HC, 127 convalescents, and 90 severe COVID-19 disease patients (50 survivors, 40 deceased). For T cells, total lymphocytes ? 800/?L, CD3+ ? 400/?L, CD4+ ? 180/?L, CD8+ ? 150/?L, B cells CD19+ ? 80/?L, and NK ? 34/?L subsets were associated with survival in severe COVID-19 disease patients. All subtypes of lymphocytes had higher concentrations in survivors than deceased, but similar between HC and convalescents. Leukocytes ? 10.150/?L or neutrophils ? 10,000/?L were associated with increased mortality. The neutrophil-to-lymphocyte ratio (NLR) ? 8.5 increased the probability of death in severe COVID-19 (odds ratio 11.68).
Conclusions: Total lymphocytes; NLR; and levels of CD3+, CD4+, CD8+, and NK cells are useful as biomarkers of survival or mortality in severe COVID-19 disease and commonly reach normal levels in convalescents.