Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201210, China.
Clinical Research Center, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
Clin Immunol. 2023 Mar;248:109271. doi: 10.1016/j.clim.2023.109271. Epub 2023 Feb 18.
Little is known about the characteristics of lymphocyte subsets and the association with patient outcomes in COVID-19 with and without impaired kidney function.
Lymphocyte subsets were compared in COVID-19 patients with or without kidney dysfunction. The primary outcome was a composite of all-cause mortality or intensive care unit admission. Secondary outcomes included duration of viral shedding, length of hospital stay, and acute kidney injury.
Lymphocyte subset cell counts demonstrated the lowest in patients with severe/critical COVID-19 and kidney dysfunction. Among all lymphocyte subset parameters, Th cell count was the most significant indicator for outcomes. ROC of the combined model of Th cell count and eGFR presented better predictive value than that of the other parameters. Th cell count <394.5 cells/μl and eGFR <87.5 ml/min/1·73m were independently associated with poor outcomes. The propensity score matching analysis revealed consistent results.
Reduced Th cell count and eGFR may be applied as promising predictive indicators for identifying COVID-19 patients with high risk and poor outcomes.
关于伴有和不伴有肾功能损害的 COVID-19 患者淋巴细胞亚群的特征及其与患者结局的关系，目前知之甚少。
比较了伴有或不伴有肾功能障碍的 COVID-19 患者的淋巴细胞亚群。主要结局是全因死亡率或重症监护病房（ICU）入院的复合结局。次要结局包括病毒脱落持续时间、住院时间和急性肾损伤。
在严重/危重症 COVID-19 合并肾功能障碍的患者中，淋巴细胞亚群细胞计数最低。在所有淋巴细胞亚群参数中，Th 细胞计数是对结局最有意义的指标。Th 细胞计数和 eGFR 联合模型的 ROC 呈现出比其他参数更好的预测价值。Th 细胞计数 <394.5 个/μl 和 eGFR <87.5 ml/min/1·73m 与不良结局独立相关。倾向评分匹配分析得出了一致的结果。
Th 细胞计数和 eGFR 降低可作为识别 COVID-19 高危和预后不良患者的有前途的预测指标。
