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Suppressed T cell-mediated immunity in patients with COVID-19: A clinical retrospective study in Wuhan, China.

Authors
  • Xu, Bo1
  • Fan, Cun-Yu1
  • Wang, An-Lu2
  • Zou, Yi-Long1
  • Yu, Yi-Han1
  • He, Cong1
  • Xia, Wen-Guang3
  • Zhang, Ji-Xian4
  • Miao, Qing5
  • 1 Hubei Provincial Hospital of Traditional Chinese & Western Medicine, Wuhan 430015, China. , (China)
  • 2 Xiyuan Hospital, China Academy of Chinese Medical Sciences, No. 1 Xiyuan Playground, Haidian District, Beijing 100091, China. , (China)
  • 3 Hubei Provincial Hospital of Traditional Chinese & Western Medicine, Wuhan 430015, China. Electronic address: [email protected] , (China)
  • 4 Hubei Provincial Hospital of Traditional Chinese & Western Medicine, Wuhan 430015, China. Electronic address: [email protected] , (China)
  • 5 Xiyuan Hospital, China Academy of Chinese Medical Sciences, No. 1 Xiyuan Playground, Haidian District, Beijing 100091, China. Electronic address: [email protected] , (China)
Type
Published Article
Journal
The Journal of infection
Publication Date
Jul 01, 2020
Volume
81
Issue
1
Identifiers
DOI: 10.1016/j.jinf.2020.04.012
PMID: 32315725
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

An ongoing outbreak of COVID-19 has exhibited significant threats around the world. We found a significant decrease of T lymphocyte subsets and an increase of inflammatory cytokines of hospitalized patients with COVID-19 in clinical practice. We conducted a retrospective, single-center observational study of in-hospital adult patients with confirmed COVID-19 in Hubei Provincial Hospital of traditional Chinese and Western medicine (Wuhan, China) by Mar 1, 2020. Demographic, clinical, laboratory information, especially T lymphocyte subsets and inflammatory cytokines were reported. For patients who died or discharge from hospital, the associations of T lymphocyte subsets on admission were evaluated by univariate logistic regression with odds ratios (ORs) and 95% confidence intervals (CIs), warning values to predict in-hospital death were assessed by Receiver Operator Characteristic (ROC) curves. A total of 187 patients were enrolled in our study from Dec 26, 2019 to Mar 1, 2020, of whom 145 were survivors (discharge = 117) or non-survivors (in-hospital death ==28). All patients exhibited a significant drop of T lymphocyte subsets counts with remarkably increasing concentrations of SAA, CRP, IL-6, and IL-10 compared to normal values. The median concentrations of SAA and CRP in critically-ill patients were nearly 4- and 10-fold than those of mild-ill patients, respectively. As the severity of COVID-19 getting worse, the counts of T lymphocyte drop lower.28 patients died in hospital, the median lymphocyte, CD3+ T-cell, CD4+ T-cell, CD8+ T-cell and B-cell were significantly lower than other patients. Lower counts (/uL) of T lymphocyte subsets lymphocyte (<500), CD3+T-cell (<200), CD4+ T-cell (<100), CD8+ T-cell (<100) and B-cell (<50) were associated with higher risks of in-hospital death of CIVID-19. The warning values to predict in-hospital death of lymphocyte, CD3+ T-cell, CD4+ T-cell, CD8+ T-cell, and B-cell were 559, 235, 104, 85 and 82, respectively. We find a significant decrease of T lymphocyte subset is positively correlated with in-hospital death and severity of illness. The decreased levels of T lymphocyte subsets reported in our study were similar with SARS but not common among other virus infection, which may be possible biomarkers for early diagnosis of COVID-19. Our findings may shed light on early warning of high risks of mortality and help early intervention and treatment of COVID-19. Copyright © 2020. Published by Elsevier Ltd.

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