Department of Nursing, Shanghai Public Health Clinical Center, Fudan University, Shanghai, P.R. China.
Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, P.R. China.
Ther Adv Respir Dis. 2021 Jan-Dec;15:17534666211049739. doi: 10.1177/17534666211049739.
The aim of this study was to investigate the predictive role of lymphocyte subsets and other laboratory measurements in patients with COVID-19.
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.
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); = 0.0002] and mortality [OR (95% CI): 0.988 (0.979, 0.99); = 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.
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.
本研究旨在探讨淋巴细胞亚群及其他实验室指标在 COVID-19 患者中的预测作用。
回顾性分析上海公共卫生临床中心确诊 COVID-19 成年患者的电子病历，获取相关数据。
患者平均年龄为 40.98±15.95 岁，男性占 58%。入住重症监护病房（ICU）、行机械通气和死亡的截断值分别为 CD4+细胞（267、198、405）、CD8+细胞（263、203、182）和 CD4+/CD8+细胞（1.4、1.8、1.4）。低于这些值表明疾病进展的可能性更高。较高的 CD4+细胞计数降低了入住 ICU[比值比（OR）（95%置信区间（CI）：0.994（0.991，0.997）； = 0.0002]和死亡的几率[OR（95%CI）：0.988（0.979，0.99）； = 0.001]，较高的 CD8+计数是 ICU 入住的独立危险因素。T 细胞计数与总淋巴细胞计数和血小板呈正相关，与 D-二聚体和乳酸脱氢酶（LDH）呈负相关。在非重症 COVID-19 患者中，CD8+T 细胞、CD4+T 细胞、总淋巴细胞计数和血小板的中位数分别为 570、362、1.45 和 211，而在重症 COVID-19 患者中，中位数分别降至 149、106、0.64 和 172。
COVID-19 患者中，较低的 T 淋巴细胞亚群与更高的 ICU 入住率、机械通气和死亡率显著相关。CD4+细胞（267、198、405）、CD8+细胞（263、203、182）和 CD4+/CD8+细胞（1.4、1.8、1.4）以下的 ICU 入住、机械通气和死亡截断值可能有助于识别疾病进展风险较高的患者。连续评估实验室指标有助于预测不良预后，并及时干预以改善结局。
