Objectives The longitudinal and systematic evaluation of immunity in coronavirus disease 2019 (COVID-19) patients is rarely reported. Methods Parameters involved in innate, adaptive, and humoral immunity were continuously monitored in COVID-19 patients from onset of illness until 45 days after symptom onset. Results This study enrolled 27 mild, 47 severe, and 46 deceased COVID-19 patients. Generally, deceased patients demonstrated a gradual increase of neutrophils and IL-6 but a decrease of lymphocytes and platelets after the onset of illness. Specifically, sustained low numbers of CD8 + T cells, NK cells, and dendritic cells were noted in deceased patients, while these cells gradually restored in mild and severe patients. Furthermore, deceased patients displayed a rapid increase of HLA-DR expression on CD4 + T cells in the early phase, but with a low level of overall CD45RO and HLA-DR expressions on CD4 + and CD8 + T cells, respectively. Notably, in the early phase, deceased patients showed a lower level of plasma cells and antigen-specific IgG, but higher expansion of CD16 + CD14 + proinflammatory monocytes and HLA-DR − CD14 + monocytic-myeloid-derived suppressor cells (M-MDSCs) than mild or severe patients. Among these immunological parameters, M-MDSCs showed the best performance in predicting COVID-19 mortality, when using a cutoff value of ≥10%. Cluster analysis found a typical immunological pattern in deceased patients on day 9 after onset, which was characterized as the increase of inflammatory markers (M-MDSCs, neutrophils, CD16 + CD14 + monocytes, and IL-6) but a decrease of host immunity markers. Conclusions This study systemically characterizes the kinetics of immunity of COVID-19, highlighting the importance of immunity in patient prognosis.
【저자키워드】 COVID-19, Adaptive immunity, Innate immunity, outcome, Humoral immunity, 【초록키워드】 coronavirus disease, Neutrophils, Monocytes, IgG, adaptive, Immunity, Prognosis, T cells, IL-6, neutrophil, NK cells, CD4, CD8, lymphocyte, T cell, Patient, Platelet, Mild, Inflammatory marker, cluster analysis, expression, patients, CD45RO, HLA-DR, dendritic cell, Plasma cell, COVID-19 patients, CD16, COVID-19 mortality, Deceased, COVID-19 patient, symptom onset, severe patients, host immunity, early phase, rapid increase, CD14, cutoff value, immunological parameters, objective, immunological, Cell, decrease, Result, enrolled, involved, reported, characterized, demonstrated, restored, sustained, these cell, systemically, highlighting, proinflammatory monocyte, 【제목키워드】 landscape, dynamic,