COVID-19
Longitudinal hematologic and immunologic variations associated with the progression of COVID-19 patients in China

https://doi.org/10.1016/j.jaci.2020.05.003Get rights and content

Background

Crucial roles of hematologic and immunologic responses in progression of coronavirus disease 2019 (COVID-19) remain largely unclear.

Objective

We sought to address the dynamic changes in hematologic and immunologic biomarkers and their associations with severity and outcomes of COVID-19.

Methods

A retrospective study including 548 patients with COVID-19 with clarified outcome (discharged or deceased) from a national cohort in China was performed. Cross-sectional and longitudinal variations were compared and the associations with different severity and outcomes were analyzed.

Results

On admission, the counts of lymphocytes, T-cell subsets, eosinophils, and platelets decreased markedly, especially in severe/critical and fatal patients. Increased neutrophil count and neutrophils-to-lymphocytes ratio were predominant in severe/critical cases or nonsurvivors. During hospitalization, eosinophils, lymphocytes, and platelets showed an increasing trend in survivors, but maintained lower levels or dropped significantly afterwards in nonsurvivors. Nonsurvivors kept a high level or showed an upward trend for neutrophils, IL-6, procalcitonin, D-dimer, amyloid A protein, and C-reactive protein, which were kept stable or showed a downward trend in survivors. Positive correlation between CD8+ T-cell and lymphocytes count was found in survivors but not in nonsurvivors. A multivariate Cox regression model suggested that restored levels of lymphocytes, eosinophils, and platelets could serve as predictors for recovery, whereas progressive increases in neutrophils, basophils, and IL-6 were associated with fatal outcome.

Conclusions

Hematologic and immunologic impairment showed a significantly different profile between survivors and nonsurvivors in patients with COVID-19 with different severity. The longitudinal variations in these biomarkers could serve to predict recovery or fatal outcome.

Key words

Hematologic indices
immunologic responses
COVID-19
severity
outcome

Abbreviations used

COVID-19
Coronavirus disease 2019
CRP
C-reactive protein
HR
Hazard ratio
MERS
Middle East respiratory syndrome
NLR
Neutrophils-to-lymphocytes ratio
PCT
Procalcitonin
PLR
Platelets-to-lymphocytes ratio
SAA
Amyloid A protein
SARS
Severe acute respiratory syndrome
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2

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Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest.

These authors contributed equally as co-first authors.

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