Abstract
Background: Identifying the immune cells involved in coronavirus disease 2019 (COVID-19) disease progression and the predictors of poor outcomes is important to manage patients adequately.
Methods: This prospective observational cohort study enrolled 48 patients with COVID-19 hospitalized in a tertiary hospital in Oman and 53 non-hospitalized patients with confirmed mild COVID-19.
Results: Hospitalized patients were older (58 years vs 36 years, P < 0.001) and had more comorbid conditions such as diabetes (65% vs 21% P < 0.001). Hospitalized patients had significantly higher inflammatory markers (P < 0.001): C-reactive protein (114 vs 4 mg/l), interleukin 6 (IL-6) (33 vs 3.71 pg/ml), lactate dehydrogenase (417 vs 214 U/l), ferritin (760 vs 196 ng/ml), fibrinogen (6 vs 3 g/l), D-dimer (1.0 vs 0.3 μg/ml), disseminated intravascular coagulopathy score (2 vs 0), and neutrophil/lymphocyte ratio (4 vs 1.1) (P < 0.001). On multivariate regression analysis, statistically significant independent early predictors of intensive care unit admission or death were higher levels of IL-6 (odds ratio 1.03, P = 0.03), frequency of large inflammatory monocytes (CD14+CD16+) (odds ratio 1.117, P = 0.010), and frequency of circulating naïve CD4+ T cells (CD27+CD28+CD45RA+CCR7+) (odds ratio 0.476, P = 0.03).
Conclusion: IL-6, the frequency of large inflammatory monocytes, and the frequency of circulating naïve CD4 T cells can be used as independent immunological predictors of poor outcomes in COVID-19 patients to prioritize critical care and resources.
Keywords: COVID-19; Immunological predictors; Inflammatory markers; Lymphocyte subsets; Mortality predictors.
【저자키워드】 COVID-19, inflammatory markers, Lymphocyte subsets, Immunological predictors, Mortality predictors., 【초록키워드】 coronavirus disease, Monocytes, Critical care, Hospitalized, intensive care, IL-6, hospital, C-reactive protein, D-dimer, ferritin, predictors, outcome, lactate dehydrogenase, Disease progression, Patient, Disseminated intravascular coagulopathy, death, Mild, fibrinogen, Inflammatory marker, predictor, Admission, CD4+ T cell, Frequency, Inflammatory, Immune cell, Odds ratio, COVID-19 patient, CD4 T cell, Oman, regression analysis, Older, naïve, circulating, identifying, inflammatory monocyte, resources, immunological, independent, enrolled, involved, can be used, significantly higher, statistically significant, diabete, comorbid condition, had more, patients with COVID-19, prospective observational cohort, 【제목키워드】 disease severity, predictor, patients with COVID-19,