Lafon Thomas, Chapuis Nicolas, Guerin Estelle, Daix Thomas, Otranto Marcela, Boumediene Ahmed, Jeannet Robin, Fontenay Michaela, Henri Hani Karam, Vignon Philippe, Monneret Guillaume, François Bruno, Jean-Philippe Jais, Feuillard Jean
Emergency Department, University Hospital Center of Limoges, 2 avenue Martin Luther King, 87042 Limoges, France.
Institut National de la Santé et de la Recherche Médicale Centre d'Investigation Clinique 1435, Centre Hospitalier Universitaire Dupuytren, 2 avenue Martin Luther King, 87042 Limoges, France.
J Leukoc Biol. 2024 May 29;115(6):1131-1142. doi: 10.1093/jleuko/qiae022.
Because one-third of patients deteriorate after their admission to the emergency department, assessing the prognosis of COVID-19 patients is of great importance. However, to date, only lymphopenia and the partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio have been reported as partly predictive of COVID-19-related further deterioration, and their association has not been evaluated. We asked whether other key biomarkers of SARS-CoV-2 immunologic defects-increase in circulating immature granulocytes, loss of monocyte HLA-DR (mHLA-DR) expression, and monocyte differentiation blockade-could also predict further COVID-19 deterioration. A series of 284 consecutive COVID-19 patients, with the sole inclusion criterion of being an adult, were prospectively enrolled at emergency department admission (day 0) of 2 different hospitals: 1 for the exploratory cohort (180 patients) and 1 for the confirmatory cohort (104 patients). Deterioration was assessed over the next 7 days. Neither increased immature granulocyte levels nor monocyte differentiation blockade predicted patient worsening. Among more than 30 clinical, biological, and radiological parameters, the value of decreased P/F ratio and lymphopenia for prediction of further COVID-19 deterioration was strongly confirmed, and the loss of mHLA-DR was the only additional independent marker. Combined together in a simple OxyLymphoMono score, the 3 variables perfectly predicted patients who did not worsen and correctly predicted worsening in 59% of cases. By highlighting lymphocyte and monocyte defects as preceding COVID-19 deterioration, these results point on early immunosuppression in COVID-19 deterioration. Combining P/F ratio, lymphopenia, and loss of mHLA-DR together in a simple and robust score could offer a pragmatic method for COVID-19 patient stratification.
由于三分之一的患者在进入急诊科后病情会恶化，因此评估新型冠状病毒肺炎（COVID-19）患者的预后至关重要。然而，迄今为止，仅有淋巴细胞减少和氧分压/吸入氧分数（PaO2/FiO2）比值被报道为可部分预测COVID-19相关的病情进一步恶化，且它们之间的关联尚未得到评估。我们探讨了严重急性呼吸综合征冠状病毒2（SARS-CoV-2）免疫缺陷的其他关键生物标志物——循环中未成熟粒细胞增多、单核细胞人类白细胞抗原-DR（mHLA-DR）表达缺失以及单核细胞分化阻滞——是否也能预测COVID-19病情的进一步恶化。在两家不同医院的急诊科入院时（第0天），前瞻性纳入了一系列连续的284例COVID-19成年患者，唯一的纳入标准是成年：1家医院用于探索性队列（180例患者），另1家医院用于验证性队列（104例患者）。在接下来的7天内评估病情恶化情况。未成熟粒细胞水平升高和单核细胞分化阻滞均不能预测患者病情恶化。在30多个临床、生物学和放射学参数中，P/F比值降低和淋巴细胞减少对预测COVID-19病情进一步恶化的价值得到了有力证实，mHLA-DR表达缺失是唯一额外的独立标志物。将这3个变量合并为一个简单的氧淋巴细胞单核细胞评分（OxyLymphoMono评分），这3个变量能完美预测病情未恶化的患者，并在59%的病例中正确预测了病情恶化。通过强调淋巴细胞和单核细胞缺陷先于COVID-19病情恶化出现，这些结果表明了COVID-19病情恶化过程中早期存在免疫抑制。将P/F比值、淋巴细胞减少和mHLA-DR表达缺失合并为一个简单且可靠的评分，可为COVID-19患者分层提供一种实用方法。
