Department of Respiratory and Critical Care Medicine, Tongji Hospital, and.
Department of Radiology, Wuhan Pulmonary Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
JCI Insight. 2020 Jul 9;5(13):139024. doi: 10.1172/jci.insight.139024.
BACKGROUNDFatal cases of COVID-19 are increasing globally. We retrospectively investigated the potential of immunologic parameters as early predictors of COVID-19.METHODSA total of 1018 patients with confirmed COVID-19 were enrolled in our 2-center retrospective study. Clinical feature, laboratory test, immunological test, radiological findings, and outcomes data were collected. Univariate and multivariable logistic regression analyses were performed to evaluate factors associated with in-hospital mortality. Receiver operator characteristic (ROC) curves and survival curves were plotted to evaluate their clinical utility.RESULTSThe counts of all T lymphocyte subsets were markedly lower in nonsurvivors than in survivors, especially CD8+ T cells. Among all tested cytokines, IL-6 was elevated most significantly, with an upward trend of more than 10-fold. Using multivariate logistic regression analysis, IL-6 levels of more than 20 pg/mL and CD8+ T cell counts of less than 165 cells/μL were found to be associated with in-hospital mortality after adjusting for confounding factors. Groups with IL-6 levels of more than 20 pg/mL and CD8+ T cell counts of less than 165 cells/μL had a higher percentage of older and male patients as well as a higher proportion of patients with comorbidities, ventilation, intensive care unit admission, shock, and death. Furthermore, the receiver operating curve of the model combining IL-6 (>20 pg/mL) and CD8+ T cell counts (<165 cells/μL) displayed a more favorable discrimination than that of the CURB-65 score. The Hosmer-Lemeshow test showed a good fit of the model, with no statistical significance.CONCLUSIONIL-6 (>20 pg/mL) and CD8+ T cell counts (<165 cells/μL) are 2 reliable prognostic indicators that accurately stratify patients into risk categories and predict COVID-19 mortality.FundingThis work was supported by funding from the National Natural Science Foundation of China (no. 81772477 and 81201848).
全球 COVID-19 死亡病例正在增加。我们回顾性研究了免疫参数作为 COVID-19 早期预测指标的潜力。
我们纳入了本 2 中心回顾性研究中的 1018 例确诊 COVID-19 患者。收集了临床特征、实验室检查、免疫检查、影像学发现和转归数据。采用单因素和多因素 logistic 回归分析评估与住院死亡率相关的因素。绘制受试者工作特征（ROC）曲线和生存曲线以评估其临床实用性。
与幸存者相比，非幸存者所有 T 淋巴细胞亚群的计数明显降低，尤其是 CD8+T 细胞。在所有测试的细胞因子中，IL-6 升高最显著，呈 10 倍以上的上升趋势。采用多元 logistic 回归分析，在校正混杂因素后，发现 IL-6 水平>20pg/ml 和 CD8+T 细胞计数<165 个/μL 与住院死亡率相关。IL-6 水平>20pg/ml 和 CD8+T 细胞计数<165 个/μL 的组中，老年和男性患者比例较高，合并症、通气、入住重症监护病房、休克和死亡的患者比例也较高。此外，联合 IL-6（>20pg/ml）和 CD8+T 细胞计数（<165 个/μL）的模型的 ROC 曲线显示出比 CURB-65 评分更好的区分度。Hosmer-Lemeshow 检验显示模型拟合良好，无统计学意义。
IL-6（>20pg/ml）和 CD8+T 细胞计数（<165 个/μL）是 2 个可靠的预后指标，可准确将患者分层为危险类别并预测 COVID-19 死亡率。
本工作得到了国家自然科学基金（No.81772477 和 81201848）的资助。
