Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
J Allergy Clin Immunol. 2020 Jul;146(1):89-100. doi: 10.1016/j.jaci.2020.05.003. Epub 2020 May 11.
Crucial roles of hematologic and immunologic responses in progression of coronavirus disease 2019 (COVID-19) remain largely unclear.
We sought to address the dynamic changes in hematologic and immunologic biomarkers and their associations with severity and outcomes of COVID-19.
A retrospective study including 548 patients with COVID-19 with clarified outcome (discharged or deceased) from a national cohort in China was performed. Cross-sectional and longitudinal variations were compared and the associations with different severity and outcomes were analyzed.
On admission, the counts of lymphocytes, T-cell subsets, eosinophils, and platelets decreased markedly, especially in severe/critical and fatal patients. Increased neutrophil count and neutrophils-to-lymphocytes ratio were predominant in severe/critical cases or nonsurvivors. During hospitalization, eosinophils, lymphocytes, and platelets showed an increasing trend in survivors, but maintained lower levels or dropped significantly afterwards in nonsurvivors. Nonsurvivors kept a high level or showed an upward trend for neutrophils, IL-6, procalcitonin, D-dimer, amyloid A protein, and C-reactive protein, which were kept stable or showed a downward trend in survivors. Positive correlation between CD8 T-cell and lymphocytes count was found in survivors but not in nonsurvivors. A multivariate Cox regression model suggested that restored levels of lymphocytes, eosinophils, and platelets could serve as predictors for recovery, whereas progressive increases in neutrophils, basophils, and IL-6 were associated with fatal outcome.
Hematologic and immunologic impairment showed a significantly different profile between survivors and nonsurvivors in patients with COVID-19 with different severity. The longitudinal variations in these biomarkers could serve to predict recovery or fatal outcome.
血液学和免疫学反应在 2019 年冠状病毒病（COVID-19）进展中的关键作用仍不清楚。
我们旨在探讨 COVID-19 患者血液学和免疫学生物标志物的动态变化及其与疾病严重程度和结局的关系。
对中国全国队列中明确结局（出院或死亡）的 548 例 COVID-19 患者进行回顾性研究。比较了横断面和纵向变化，并分析了它们与不同严重程度和结局的关系。
入院时，淋巴细胞、T 细胞亚群、嗜酸性粒细胞和血小板计数明显下降，尤其是在重症/危重症和死亡患者中。中性粒细胞计数和中性粒细胞与淋巴细胞比值增加主要见于重症/危重症患者或非幸存者。住院期间，幸存者的嗜酸性粒细胞、淋巴细胞和血小板呈上升趋势，但非幸存者的这些指标水平保持较低或随后显著下降。非幸存者的中性粒细胞、白细胞介素 6（IL-6）、降钙素原、D-二聚体、淀粉样 A 蛋白和 C 反应蛋白水平保持较高或呈上升趋势，而幸存者的这些指标则保持稳定或呈下降趋势。在幸存者中发现 CD8+T 细胞与淋巴细胞计数之间存在正相关，但在非幸存者中则没有。多变量 Cox 回归模型表明，淋巴细胞、嗜酸性粒细胞和血小板水平的恢复可作为恢复的预测指标，而中性粒细胞、嗜碱性粒细胞和 IL-6 的逐渐增加与死亡结局相关。
COVID-19 患者严重程度不同，幸存者和非幸存者的血液学和免疫学损伤表现出明显不同的特征。这些生物标志物的纵向变化可用于预测恢复或死亡结局。
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