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The predictive role of lymphocyte subsets and laboratory measurements in COVID-19 disease: a retrospective study
Lin Wang1, Jun Chen2, Jun Zhao3
1Department of Nursing, Shanghai Public Health Clinical Center, Fudan University, Shanghai, P.R. China.
Insights
Lower T lymphocyte subsets, including CD4+ and CD8+ cells, predict severe COVID-19 outcomes. Specific cell count cutoffs can identify patients at high risk for intensive care unit admission, mechanical ventilation, and mortality.
Area of Science:
- Immunology
- Virology
- Clinical Medicine
Background:
- COVID-19, a global pandemic, presents a wide spectrum of disease severity.
- Understanding predictive biomarkers is crucial for managing patients and improving outcomes.
- Lymphocyte subsets play a key role in the immune response to viral infections.
Purpose of the Study:
- To investigate the predictive value of lymphocyte subsets in COVID-19 patients.
- To identify laboratory markers associated with disease progression and adverse outcomes.
Main Methods:
- Retrospective review of electronic medical records of adult COVID-19 patients.
- Analysis of lymphocyte subsets (CD4+, CD8+, CD4+/CD8+ ratio) and other laboratory parameters.
- Statistical analysis to determine correlations and predictive cutoffs for ICU admission, mechanical ventilation, and mortality.
Main Results:
- Lower CD4+ and CD8+ T-cell counts were associated with increased risk of ICU admission, mechanical ventilation, and mortality.
- Established cutoff values for CD4+ cells (267), CD8+ cells (263), and CD4+/CD8+ ratio (1.4) for predicting adverse events.
- T-cell counts correlated with total lymphocyte count, platelets, D-dimer, and LDH levels.
Conclusions:
- T lymphocyte subsets are significant predictors of COVID-19 severity and prognosis.
- Defined cutoff values can aid in identifying high-risk patients requiring closer monitoring and intervention.
- Continuous monitoring of laboratory indices is recommended for timely management and improved patient outcomes.
Aim:
The aim of this study was to investigate the predictive role of lymphocyte subsets and other laboratory measurements in patients with COVID-19.
Methods:
Electronic medical records of adult patients with confirmed diagnosis of COVID-19 from the Shanghai Public Health Clinical Center were reviewed retrospectively to obtain relevant data.
Results:
The mean age of patients was 40.98 ± 15.95 years, with 58% of the patients being males. The cutoff values at the intensive care unit (ICU) admission, mechanical ventilation, and mortality were CD4+ cells (267, 198, and 405), CD8+ cells (263, 203, and 182), and CD4+ /CD8+ cells (1.4, 1.8, and 1.4). The cutoffs below these values indicate the higher chances of disease progression. Higher CD4+ cell count led to lesser chances for ICU admission [odds ratio (OR) (95% confidence interval (CI): 0.994 (0.991, 0.997); p = 0.0002] and mortality [OR (95% CI): 0.988 (0.979, 0.99); p = 0.001], higher CD8+ count was an independent risk factor for ICU admission. T-cell count positively correlated with total lymphocyte count and platelets, while negatively correlated with D-dimer and lactate dehydrogenase (LDH). Among patients with non-severe COVID-19, median CD8+ T cell, CD4+ T cell, total lymphocyte count, and platelets were 570, 362, 1.45, and 211, respectively, while median values decreased to 149, 106, 0.64, and 172, respectively, in patients with severe COVID-19.
Conclusion:
Lower T lymphocyte subsets were significantly associated with higher admission to ICU, mechanical ventilation, and mortality among patients with COVID-19. A cutoff value of ICU admission, mechanical ventilation, and mortality below CD4+ cells (267, 198, and 405), CD8+ cells (263, 203, 182), and CD4+/CD8+ cells (1.4, 1.8, 1.4) may help identify patients at high risk of disease progression. The continuous evaluation of laboratory indices may help with dismal prognosis and prompt intervention to improve outcomes.
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