Di Lorenzo Andrea, Tedde Simona, Pace Pier Giorgio, Campogiani Laura, Ansaldo Lorenzo, Lodi Alessandra, Zordan Marta, Barreca Filippo, Caldara Federica, Rossi Benedetta, Imeneo Alessandra, Alessio Grazia, Crea Angela Maria Antonia, Checchi Davide, Malagnino Vincenzo, Teti Elisabetta, Coppola Luigi, Palmieri Raffaele, Buccisano Francesco, Andreoni Massimo, Sarmati Loredana, Iannetta Marco
Department of System Medicine, Tor Vergata University, 00133 Rome, Italy.
Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy.
Biomedicines. 2022 Nov 2;10(11):2788. doi: 10.3390/biomedicines10112788.
Lymphopenia has been consistently reported as associated with severe coronavirus disease 2019 (COVID-19). Several studies have described a profound decline in all T-cell subtypes in hospitalized patients with severe and critical COVID-19. The aim of this study was to assess the role of T-lymphocyte subset absolute counts measured at ward admission in predicting 30-day mortality in COVID-19 hospitalized patients, validating a new prognostic score, the T-Lymphocyte Subset Index (TLSI, range 0−2), based on the number of T-cell subset (CD4+ and CD8+) absolute counts that are below prespecified cutoffs. These cutoff values derive from a previously published work of our research group at Policlinico Tor Vergata, Rome, Italy: CD3+CD4+ < 369 cells/μL, CD3+CD8+ < 194 cells/μL. In the present single-center retrospective study, T-cell subsets were assessed on admission to the infectious diseases ward. Statistical analysis was performed using JASP (Version 0.16.2. JASP Team, 2022, Amsterdam, The Netherlands) and Prism8 (version 8.2.1. GraphPad Software, San Diego, CA, USA). Clinical and laboratory parameters of 296 adult patients hospitalized because of COVID-19 were analyzed. The overall mortality rate was 22.3% (66/296). Survivors (S) had a statistically significant lower TLSI score compared to non-survivors (NS) (p < 0.001). Patients with increasing TLSI scores had proportionally higher rates of 30-day mortality (p < 0.0001). In the multivariable logistic analysis, the TLSI was an independent predictor of in-hospital 30-day mortality (OR: 1.893, p = 0.003). Survival analysis showed that patients with a TLSI > 0 had an increased risk of death compared to patients with a TLSI = 0 (hazard ratio: 2.83, p < 0.0001). The TLSI was confirmed as an early and independent predictor of COVID-19 in-hospital 30-day mortality.
淋巴细胞减少症一直被报道与严重的2019冠状病毒病（COVID-19）相关。多项研究描述了重症和危重症COVID-19住院患者所有T细胞亚群的显著下降。本研究的目的是评估在病房入院时测量的T淋巴细胞亚群绝对计数在预测COVID-19住院患者30天死亡率中的作用，验证一种新的预后评分，即T淋巴细胞亚群指数（TLSI，范围0 - 2），该评分基于低于预先设定临界值的T细胞亚群（CD4 +和CD8 +）绝对计数的数量。这些临界值来自我们意大利罗马托尔韦尔加塔大学综合医院研究小组之前发表的一项研究：CD3 + CD4 + < 369个细胞/μL，CD3 + CD8 + < 194个细胞/μL。在本单中心回顾性研究中，在传染病病房入院时评估T细胞亚群。使用JASP（版本0.16.2。JASP团队，2022年，荷兰阿姆斯特丹）和Prism8（版本8.2.1。GraphPad软件，美国加利福尼亚州圣地亚哥）进行统计分析。分析了296例因COVID-19住院的成年患者的临床和实验室参数。总死亡率为22.3%（66/296）。与非幸存者（NS）相比，幸存者（S）的TLSI评分在统计学上显著更低（p < 0.001）。TLSI评分升高的患者30天死亡率成比例更高（p < 0.0001）。在多变量逻辑分析中，TLSI是住院30天死亡率的独立预测因子（OR：1.893，p = 0.003）。生存分析表明，与TLSI = 0的患者相比，TLSI > 0的患者死亡风险增加（风险比：2.83，p < 0.0001）。TLSI被确认为COVID-19住院30天死亡率的早期独立预测因子。
