Hemodialysis patients (HD) are expected to have excess mortality in coronavirus disease 2019 (COVID-19). This was challenged by a recent study reporting HD patients to have comparable mortality and less ICU admissions when hospitalized with COVID-19. An altered immune system due to chronic inflammation might protect HD-patients from severe COVID-19. Therefore, we aimed to describe the peripheral blood immune phenotype in HD-patients and respective controls with COVID-19. Methods Sixty-four patients (31 HD, 33 non-HD) with PCR-confirmed COVID-19 and 16 control patients (10 HD, 6 non-HD) were prospectively included. According to symptoms, COVID-19 patients were categorized as asymptomatic/mild, moderate or severe COVID-19 phenotypes. Cytokine profiling and immune phenotyping was performed. Results Th1 and Th17 plasma cytokine levels were highly increased in HD patients without COVID-19 and were not significantly regulated during COVID-19. In non-HD COVID-19 patients these cytokines increased significantly with disease severity. While all patients with moderate or severe COVID-19 showed hallmarks of COVID-19 such as decreased CD3 + , CD4 + and CD8 + and CD4 + CD25 hi FoxP3 + regulatory T cells, significantly increased CD38 + CD8 + effector memory and CD38 + CD8 + TEMRA T cells were detected in moderate/severe COVID-19 HD patients, which was not observed in non-HD patients with moderate or severe COVID-19. Furthermore, CD161 + CD8 + T cells decreased significantly in non-HD COVID-19 patients dependent on disease severity, but not in HD patients. Dynamics of B cells and subtypes were comparable in HD and non-HD COVID-19 patients. Conclusions HD patients might be protected from severe COVID-19 due to their chronic inflammatory state with increased CD38 + CD8 + effector memory and TEMRA T cells as well as CD161 + CD8 + T cells.
【저자키워드】 COVID-19, Inflammation, Cytokines, hemodialysis patients, CD8+ T cells, 【초록키워드】 coronavirus disease, Coronavirus disease 2019, Cytokines, Hospitalized, Mortality, severe COVID-19, T cells, disease severity, Dynamics, Th1, Th17, B cells, cytokine, immune system, CD4, CD8, Symptoms, immune, Peripheral blood, B cell, T cell, Hemodialysis, Patient, ICU admission, Control, excess mortality, chronic inflammation, moderate, patients, CD25, CD38, regulatory T cells, FOXP3, COVID-19 patients, COVID-19 patient, inflammatory state, Phenotypes, Immune phenotype, Subtypes, PCR-confirmed COVID-19, hallmark, hallmarks, while, subtype, effector memory, Plasma cytokine, TEMRA, CD3, significantly increased, PROTECT, Result, significantly, was performed, less, dependent on, comparable, regulated, expected, control patient, patients with moderate, patients without COVID-19, with COVID-19, 【제목키워드】 chronic,