Rationale : Previous studies of coronavirus disease 2019 (COVID-19) were mainly focused on cross-sectional analysis. In this study, we sought to evaluate the dynamic changes of immunological and radiographic features, and the association with the outcome of pulmonary lesions in COVID-19 patients. Methods : Peripheral blood samples and radiographic data were collected longitudinally for up to 8 weeks from 158 laboratory-confirmed COVID-19 patients. The chest computed tomography (CT) scans were scored based on a semi-quantification assessment according to the extent of pulmonary abnormalities; the temporal change of the immunological and radiographic features was analyzed. Results: Compared with mild and moderate patients, severe patients had significantly decreased counts of lymphocytes, CD4 + T cells, CD8 + T cells, and CD19 + B cells but dramatically elevated counts of neutrophils and levels of interleukin (IL)-6. Sequential monitoring showed a sustained increase in lymphocytes counts and significantly decreased levels of IL-6 in severe patients during the disease course. Notably, patients with persistent pulmonary lesions (CT score ≥ 5 in week 8) showed high levels of IL-6 during the follow-up period, compared with those with recovery lesions (CT score < 5 in week 8). More importantly, the peak expression of IL-6 prior to the aggravated lung injury was mainly found in patients with persistent lesions, and multivariate analysis showed that IL-6 level upon admission was an independent factor associated with the persistent pulmonary injury. Conclusion: Prolonged elevation of IL-6 is associated with persistent pulmonary lesions in COVID-19 patients. Sequential monitoring and timely intervention of IL-6 may favor the clinical management of COVID-19.
【저자키워드】 COVID-19, interleukin-6, Chest CT, pulmonary injury, sequential monitoring, 【초록키워드】 coronavirus disease, Neutrophils, Coronavirus disease 2019, Lymphocytes, T cells, IL-6, neutrophil, B cells, Intervention, Lung injury, outcome, CD4, CD8, Peripheral blood, B cell, Computed tomography, Chest computed tomography, lymphocyte, interleukin, Features, Patient, Clinical management, Mild, pulmonary injury, Severe patient, expression, change, Admission, moderate, patients, COVID-19 patients, association, Multivariate analysis, Prolonged, Analysis, CD19, lesion, follow-up period, severe patients, Previous studies, lesions, cross-sectional analysis, disease course, rationale, favor, pulmonary lesions, Radiographic, previous study, peripheral blood samples, laboratory-confirmed, immunological, feature, independent, Course, analyzed, collected, evaluate, significantly, the disease, elevated, increase in, sustained, pulmonary lesion, Peripheral blood sample, scored, semi-quantification, 【제목키워드】 interleukin-6, longitudinal, Radiographic, reveal,