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Immunological predictors of disease severity in patients with COVID-19
Asma Al Balushi1, Jalila AlShekaili2, Mahmood Al Kindi2
1Tropical and Infectious Diseases Unit, The Royal Liverpool University Hospital, Liverpool, UK; Internal Medicine Department, Suhar Hospital, Suhar, Oman.
Insights
Predictors of severe COVID-19 include elevated interleukin-6 (IL-6), inflammatory monocytes, and specific CD4 T cells. Identifying these immune markers aids in prioritizing critical care for COVID-19 patients.
Area of Science:
- Immunology
- Infectious Diseases
- Critical Care Medicine
Background:
- Understanding immune responses in COVID-19 is crucial for patient management.
- Identifying predictors of severe disease and poor outcomes is essential.
Purpose of the Study:
- To identify immunological predictors of poor outcomes in hospitalized COVID-19 patients.
- To differentiate immune cell profiles between hospitalized and non-hospitalized COVID-19 cases.
Main Methods:
- Prospective observational cohort study of 48 hospitalized and 53 non-hospitalized COVID-19 patients.
- Analysis of demographic data, comorbid conditions, and inflammatory markers.
- Multivariate regression analysis to identify independent predictors of intensive care unit (ICU) admission or death.
Main Results:
- Hospitalized patients were older and had more comorbidities, with significantly higher inflammatory markers (IL-6, CRP, ferritin, etc.).
- Higher levels of interleukin-6 (IL-6), frequency of large inflammatory monocytes (CD14+CD16+), and frequency of circulating naïve CD4+ T cells (CD27+CD28+CD45RA+CCR7+) were independent predictors of ICU admission or death.
Conclusions:
- Interleukin-6 (IL-6), inflammatory monocytes, and naïve CD4 T cells serve as independent immunological predictors of poor COVID-19 outcomes.
- These markers can guide prioritization for critical care and resource allocation in COVID-19 management.
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.
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