Daenen Katrijn, van Hooijdonk Samantha, Tong-Minh Kirby, Dik Willem A, van Hagen Petrus M, Huijben Jilske A, Gommers Diederik, van Gorp Eric C M, Endeman Henrik, Dalm Virgil A S H
Department of Intensive Care, Erasmus University Medical Center, Rotterdam, Netherlands.
Department of Viroscience, Erasmus University Medical Center, Rotterdam, Netherlands.
Front Immunol. 2024 Dec 3;15:1436637. doi: 10.3389/fimmu.2024.1436637. eCollection 2024.
INTRODUCTION: Severe COVID-19 is associated with reduced absolute lymphocyte counts, suggesting that lymphocyte subsets may serve as predictors of clinical outcomes in affected patients. Early identification of patients at risk for severe disease is crucial for optimizing care, accurately informing patients and their families, guiding therapeutic interventions, and improving patient flow in the ED. Given that immunosuppressive drugs significantly impact lymphocyte profiles, we aimed to determine the association between prior use of immunosuppressive drugs, lymphocyte subsets, and COVID-19 severity in our population with a high prevalence of immunosuppression. METHODS: In 2021, suspected COVID-19 patients were included in the ED. Lymphocyte subsets were determined in peripheral blood within 24 hours after presentation and comparative analyses was performed between SARS-CoV-2 negative and positive patients, mild versus severe disease and patients with and without prior immunosuppressive drug use. Mild cases were patients discharged home or admitted to a general ward, severe cases were patients with COVID-19-related mortality or necessitating ICU admission. Logistic regression analysis was performed to assess the association between lymphocyte subsets and COVID-19 severity, and between prior immunosuppressive drug use and COVID-19 severity. RESULTS: Twenty-five SARS-CoV-2 negative and 77 SARS-CoV-2 positive patients were included, whereof 57 (74%) had mild and 20 (26%) severe COVID-19. No significant differences were observed in the absolute counts of CD3+, CD4+, and CD8+ T-lymphocytes, B-lymphocytes, and NK-cells between SARS-CoV-2 negative and positive patients or between mild and severe cases. The 36 patients with prior use of immunosuppressive drugs had significantly lower CD4+ T-lymphocytes (p<0.01). Prior use of immunosuppressive drugs was not associated with COVID-19 severity (adjusted OR 1.074, 0.355-3.194). CONCLUSION: Lymphocyte subsets were not significantly different between SARS-CoV-2 negative and positive patients and between mild versus severe cases. Neither lymphocyte subsets nor prior immunosuppressive drug use were associated with COVID-19 severity.
引言：重症新型冠状病毒肺炎（COVID-19）与绝对淋巴细胞计数减少有关，这表明淋巴细胞亚群可能是受影响患者临床结局的预测指标。早期识别重症疾病风险患者对于优化治疗、准确告知患者及其家属、指导治疗干预以及改善急诊科患者流程至关重要。鉴于免疫抑制药物会显著影响淋巴细胞谱，我们旨在确定在免疫抑制患病率较高的人群中，既往使用免疫抑制药物、淋巴细胞亚群与COVID-19严重程度之间的关联。 方法：2021年，急诊科纳入疑似COVID-19患者。在就诊后24小时内测定外周血中的淋巴细胞亚群，并对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）阴性和阳性患者、轻症与重症患者以及既往使用和未使用免疫抑制药物的患者进行比较分析。轻症患者为出院回家或入住普通病房的患者，重症患者为与COVID-19相关死亡或需要入住重症监护病房（ICU）的患者。进行逻辑回归分析以评估淋巴细胞亚群与COVID-19严重程度之间以及既往使用免疫抑制药物与COVID-19严重程度之间的关联。 结果：纳入25例SARS-CoV-2阴性和77例SARS-CoV-2阳性患者，其中57例（74%）为轻症COVID-19，20例（26%）为重症COVID-19。SARS-CoV-2阴性和阳性患者之间或轻症与重症病例之间，CD3⁺、CD4⁺和CD8⁺T淋巴细胞、B淋巴细胞和自然杀伤（NK）细胞的绝对计数无显著差异。3名既往使用免疫抑制药物的患者CD4⁺T淋巴细胞显著减少（p<0.01）。既往使用免疫抑制药物与COVID-19严重程度无关（调整后的比值比为1.074，95%置信区间为0.355-3.194）。 结论：SARS-CoV-2阴性和阳性患者之间以及轻症与重症病例之间，淋巴细胞亚群无显著差异。淋巴细胞亚群和既往使用免疫抑制药物均与COVID-19严重程度无关。
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