Eryılmaz-Eren Esma, Köker Mustafa Yavuz, Ulu-Kılıç Aysegul, Hürmet-Öz Hatice Tuna, Ay-Altıntop Yasemin, Saatçi Esma, Özsoy Sevil, Kılınç-Toker Ayşin, Topaloğlu Ulaş Serkan, Yüksel Recep Civan, Avcılar Hüseyin, Beştepe-Dursun Zehra, Çelik İlhami
Department of Infectious Diseases and Clinical Microbiology, Kayseri City Education and Research Hospital, Kayseri, Turkey.
Department of Immunology, Erciyes University School of Medicine, Kayseri, Turkey.
Infect Dis Clin Microbiol. 2023 Mar 11;5(1):23-30. doi: 10.36519/idcm.2023.190. eCollection 2023 Mar.
Most patients with coronavirus disease (COVID-19) have abnormalities of lymphocyte subsets. This study aimed to determine the distribution of lymphocytes in patients with various severity levels of COVID-19 and to describe the relationship between the CD4 T helper and prognosis.
Adult (>18 years old) patients with COVID-19 who followed up in a tertiary hospital were included in the study prospectively. Demographic and clinical characteristics of the patients were obtained from the hospital records. Peripheral flow cytometry was studied in patients with different severity of COVID-19 and different prognoses. Next, we analyzed the characteristics and predictive values of lymphocyte subsets in COVID-19 patients.
Totally 86 patients were included in the study, of which 21 (24.4%) had asymptomatic, 23 (26.7%) had mild/moderate, and 42 (48.8%) had severe/critical COVID-19. Severe/critical patients had lower lymphocyte levels and older age than asymptomatic patients (<0.001 and <0.001, respectively). We determined that decreased CD4 T cell ratio (<0.001) and CD4 /CD8 ratio (<0.001) were indicative of the severity of the disease. CD4 T cell ratio on admission (odds ratio [OR]=0.858; =0.033), day seven CD4 T cell ratio (OR=0.840; =0.029), and C-reactive protein (CRP) levels (OR=1.014; =0.043) were prognostic factors for mortality. According to receiver operating characteristics (ROC) curve analysis, the area under the curve was greater than 0.9 for decreased CD4 T cell ratio on admission and the seventh day.
A low CD4 T helper ratio predicts a poor prognosis. In combination with CRP, it can be used in clinical follow-up.
大多数冠状病毒病（COVID-19）患者存在淋巴细胞亚群异常。本研究旨在确定不同严重程度的COVID-19患者淋巴细胞的分布情况，并描述CD4辅助性T细胞与预后之间的关系。
前瞻性纳入在一家三级医院随访的成年（>18岁）COVID-19患者。患者的人口统计学和临床特征从医院记录中获取。对不同严重程度和不同预后的COVID-19患者进行外周流式细胞术研究。接下来，我们分析了COVID-19患者淋巴细胞亚群的特征和预测价值。
本研究共纳入86例患者，其中21例（24.4%）为无症状感染者，23例（26.7%）为轻症/中症患者，42例（48.8%）为重症/危重症COVID-19患者。重症/危重症患者的淋巴细胞水平低于无症状患者（分别<0.001和<0.001），年龄也大于无症状患者。我们确定CD4 T细胞比例降低（<0.001）和CD4/CD8比例降低（<0.001）表明疾病的严重程度。入院时的CD4 T细胞比例（比值比[OR]=0.858；P=0.033）、第7天的CD4 T细胞比例（OR=0.840；P=0.029）和C反应蛋白（CRP）水平（OR=1.014；P=0.043）是死亡的预后因素。根据受试者工作特征（ROC）曲线分析，入院时和第7天CD4 T细胞比例降低的曲线下面积大于0.9。
低CD4辅助性T细胞比例预示预后不良。与CRP联合使用，可用于临床随访。
