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Peripheral Plasma Cells Associated with Mortality Benefit in Severe COVID-19: A Marker of Disease Resolution
Mary Boulanger1, Emily Molina1, Kunbo Wang2
1Department of Medicine, Johns Hopkins Hospital, Baltimore, Md.
Insights
Detecting plasma cells in severe COVID-19 patients is linked to improved survival. These cells, though rare in blood, may play a crucial role in the immune response to SARS-CoV-2 infection.
Area of Science:
- Immunology
- Virology
- Critical Care Medicine
Background:
- Severe COVID-19 is associated with cytokine storms impacting immune cells.
- Plasma cells, crucial for antibody production, are typically not found in peripheral blood.
- Their presence in COVID-19 patients may indicate a specific immune response.
Purpose of the Study:
- To investigate the association between peripheral blood plasma cells and disease severity in hospitalized COVID-19 patients.
- To determine if the presence of plasma cells impacts mortality and clinical improvement in severe cases.
Main Methods:
- Utilized the Johns Hopkins COVID-19 Precision Medicine Analytics Platform Registry.
- Identified hospitalized adult patients with confirmed SARS-CoV-2 infection.
- Employed flow cytometry and microscopy to detect plasma cells, analyzing outcomes using Cox regression models.
Main Results:
- Of 2301 patients, 371 had detectable plasma cells, often developing after severe disease onset.
- In severe COVID-19, plasma cells were associated with reduced hazard of death (aHR: 0.57; P=.008) after covariate adjustment.
- No significant association was found between plasma cells and time to clinical improvement.
Conclusions:
- Detectable peripheral blood plasma cells in severe COVID-19 patients correlate with improved survival.
- The findings suggest a potentially protective role for plasma cells in severe SARS-CoV-2 infection.
- Further research is needed to elucidate the precise mechanisms of plasma cell involvement in the COVID-19 immune response.
Background:
Cytokines seen in severe coronavirus disease 2019 (COVID-19) are associated with proliferation, differentiation, and survival of plasma cells. Plasma cells are not routinely found in peripheral blood, though may produce virus-neutralizing antibodies in COVID-19 later in the course of an infection.
Methods:
Using the Johns Hopkins COVID-19 Precision Medicine Analytics Platform Registry, we identified hospitalized adult patients with confirmed severe acute respiratory coronavirus 2 (SARS-CoV-2) infection and stratified by presence of plasma cells and World Health Organization (WHO) disease severity. To identify plasma cells, we employed a sensitive flow cytometric screening method for highly fluorescent lymphocytes and confirmed these microscopically. Cox regression models were used to evaluate time to death and time to clinical improvement by the presence of plasma cells in patients with severe disease.
Results:
Of 2301 hospitalized patients with confirmed infection, 371 had plasma cells identified. Patients with plasma cells were more likely to have severe disease, though 86.6% developed plasma cells after onset of severe disease. In patients with severe disease, after adjusting for age, sex, body mass index, race, and other covariates associated with disease severity, patients with plasma cells had a reduced hazard of death (adjusted hazard ratio: 0.57; 95% confidence interval: 0.38-0.87; P value: .008). There was no significant association with the presence of plasma cells and time to clinical improvement.
Conclusions:
Patients with severe disease who have detectable plasma cells in the peripheral blood have improved mortality despite adjusting for known covariates associated with disease severity in COVID-19. Further investigation is warranted to understand the role of plasma cells in the immune response to COVID-19.
