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Increased CD4/CD8 T-cell ratio : A risk factor for mortality in patients with coronavirus disease 2019
A Z Arjana1, K A T Amijaya1, S Adventia1
1Universitas Gadjah Mada, Public Health, and Nursing, Faculty of Medicine, Department of Clinical Pathology and Laboratory Medicine, Yogyakarta, Indonesia.
Insights
An elevated CD4/CD8 T-cell ratio (>1.26) significantly increases the risk of 28-day in-hospital mortality in COVID-19 patients. This finding highlights the CD4/CD8 ratio as a potential prognostic marker for COVID-19 severity.
Area of Science:
- Immunology
- Virology
- Clinical Medicine
Background:
- CD4 and CD8 T-lymphocytes are crucial immune cells, but their specific roles in COVID-19 prognosis are not fully understood.
- Understanding T-cell dynamics is vital for predicting patient outcomes in infectious diseases like COVID-19.
Purpose of the Study:
- To investigate the CD4/CD8 T-cell ratio as a predictive factor for 28-day in-hospital mortality in COVID-19 patients.
- To establish a potential risk stratification tool for severe COVID-19 cases.
Main Methods:
- Prospective cohort study involving 85 confirmed COVID-19 patients.
- Measurement of CD4 and CD8 T-cell absolute counts using flow cytometry.
- Calculation of the CD4/CD8 ratio and statistical analysis including ROC and Kaplan-Meier.
Main Results:
- A CD4/CD8 T-cell ratio cutoff of 1.26 was identified with an area under the curve of 0.68 (p=0.005).
- Patients with a CD4/CD8 ratio >1.26 exhibited a 2.91-fold increased risk of 28-day in-hospital mortality (Hazard Ratio = 2.91, p=0.0052).
Conclusions:
- An increased CD4/CD8 T-cell ratio (>1.26) is a significant risk factor for mortality in COVID-19 patients.
- The CD4/CD8 ratio may serve as a valuable prognostic biomarker for predicting severe outcomes in COVID-19 hospitalization.
Introduction:
Although CD4 and CD8 T-cells are the main subset of T-lymphocytes, their roles in COVID-19 infection and severity remain unclear. This study aimed to determine the role of increased CD4/CD8 T-cells ratio as a risk factor for cases of 28-days in-hospital mortality in COVID-19 patients.
Materials And Methods:
This study employed a prospective cohort design. Inclusion criteria were confirmed COVID-19 cases with a positive polymerase chain reaction report. CD4 and CD8 T-cells absolute counts were measured by flow cytometry. The CD4/CD8 ratio was calculated by dividing the absolute count of CD4 by that of CD8 T-cells.
Results:
A total of 85 subjects were followed for 28 days. The mean age of the subjects was 52.64 years, and majority of them were females (51.8%). Twenty-eight (32.9%) subjects died within 28 days of follow-up. Receiver operating characteristics analysis obtained an area under curve of 0.68 with the cut-off value 1.26 with p = 0.005. Kaplan-Meier's analysis obtained Hazard Ratio 2.91 (95%CI 1.377-6.161; p = 0.0052).
Conclusion:
Subjects with an increase in CD4/CD8 T-cells ratio >1.26 had a 2.91-times risk of 28 days in-hospital mortality.
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