The clinical course and its correlated immune status in COVID-19 pneumonia

J Clin Virol. 2020 Jun;127:104361. doi: 10.1016/j.jcv.2020.104361. Epub 2020 Apr 12.

Abstract

Objectives: To explore the clinical course and its dynamic features of immune status in COVID-19 patients and find predictors correlated with severity and prognosis of COVID-19.

Methods: The electronic medical records of 204 patients with COVID-19 pneumonia confirmed by nucleic acid testing were retrospectively collected and analyzed.

Results: All patients were divided into severe (69) and non-severe group (135). Lymphocyte subsets count, including CD3+ T cell, CD4+ T cell, CD8+ T cell, B cell (CD19+) and NK cell (CD16+ 56+), were significantly lower in severe group (P<0.001). The dynamic levels of T lymphocyte in severe group were significantly lower from disease onset, but in the improved subgroup the value of T lymphocyte began to increase after about 15-day treatment and finally returned to the normal level. The cut-off value of the counts of CD3+ (576), CD4+ (391) and CD8+ (214) T cell were calculated and indicated significantly high sensitivity and specificity for severity of COVID-19.

Conclusion: Our results shown that the decrease of CD3+, CD4+ and CD8+ T lymphocyte correlated with the course of patients with COVID-19 pneumonia, especially in severe cases. The level of T lymphocyte could be used as an indicator for prediction of severity and prognosis of patients with COVID-19 pneumonia. The application of glucocorticoid should be cautious in severe cases.

Keywords: COVID-19; SARS-CoV-2; immunity; lymphocyte subsets.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Betacoronavirus
  • COVID-19
  • Coronavirus Infections / complications*
  • Coronavirus Infections / immunology*
  • Electronic Health Records
  • Female
  • Humans
  • Lymphocyte Count
  • Lymphocyte Subsets / immunology*
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / immunology*
  • Prognosis
  • Retrospective Studies
  • SARS-CoV-2
  • Severity of Illness Index
  • T-Lymphocyte Subsets / immunology