Lee Jongmin, Park Sung-Soo, Kim Tong Yoon, Lee Dong-Gun, Kim Dong-Wook
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, The Catholic University of Korea, Seoul 06591, Korea.
Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
Cancers (Basel). 2021 Jan 26;13(3):471. doi: 10.3390/cancers13030471.
We aimed to identify whether lymphopenia is a reliable prognostic marker for COVID-19. Using data derived from a Korean nationwide longitudinal cohort of 5628 COVID-19 patients, we identified propensity-matched cohorts ( = 770) with group I of severe lymphopenia (absolute lymphocyte counts [ALC]: <500/mm, = 110), group II of mild-to-moderate lymphopenia (ALC: ≥500-<1000/mm, = 330), and group III, no lymphopenia (ALC: ≥1000/mm, = 330). A significantly higher mortality rate was associated with lymphopenia severity: 40% in group I, 22.7% in group II, and 13.0% in group III ( < 0.001). At 28 days, the estimated inferior overall survival associated with intensified lymphopenia: 62.7% in group I, 79.9% in group II, and 89.0% in group III ( < 0.001). Lymphopenia contributed significantly toward a greater need for interventions in all groups but at varying degrees: requirements of invasive ventilation, intensive oxygen supply, or adequate oxygen supply, respectively ( < 0.001). The lymphopenia intensity was independently associated with higher COVID-19 mortality in multivariable analysis; adjusted odds ratios of 5.63 (95% CI, 3.0-10.72), and 2.47 (95% CI, 1.5-4.13) for group I and group II, respectively. Lymphopenia and its severity levels may serve as reliable predictive factors for COVID-19 clinical outcomes; thus, lymphopenia may provide the prognostic granularity required for clinical use in the management of patients with COVID-19.
我们旨在确定淋巴细胞减少是否是新冠病毒病（COVID-19）的可靠预后标志物。利用来自韩国全国5628例COVID-19患者纵向队列的数据，我们确定了倾向匹配队列（n = 770），其中第一组为严重淋巴细胞减少（绝对淋巴细胞计数[ALC]：<500/mm³，n = 110），第二组为轻度至中度淋巴细胞减少（ALC：≥500 - <1000/mm³，n = 330），第三组为无淋巴细胞减少（ALC：≥1000/mm³，n = 330）。淋巴细胞减少的严重程度与显著更高的死亡率相关：第一组为40%，第二组为22.7%，第三组为13.0%（P < 0.001）。在28天时，淋巴细胞减少加剧与总体生存较差相关：第一组为62.7%，第二组为79.9%，第三组为89.0%（P < 0.001）。淋巴细胞减少在所有组中均显著导致对干预措施的更大需求，但程度不同：分别为有创通气、强化氧气供应或充足氧气供应的需求（P < 0.001）。在多变量分析中，淋巴细胞减少的强度与更高的COVID-19死亡率独立相关；第一组和第二组的调整比值比分别为5.63（95%CI，3.0 - 10.72）和2.47（95%CI，1.5 - 4.13）。淋巴细胞减少及其严重程度水平可能是COVID-19临床结局的可靠预测因素；因此，淋巴细胞减少可为COVID-19患者管理中的临床应用提供所需的预后精细度。
