IL-6 and CD8+ T cell counts combined are an early predictor of in-hospital mortality of patients with COVID-19

JCI Insight. 2020 Jul 9;5(13):e139024. doi: 10.1172/jci.insight.139024.

Abstract

BACKGROUNDFatal cases of COVID-19 are increasing globally. We retrospectively investigated the potential of immunologic parameters as early predictors of COVID-19.METHODSA total of 1018 patients with confirmed COVID-19 were enrolled in our 2-center retrospective study. Clinical feature, laboratory test, immunological test, radiological findings, and outcomes data were collected. Univariate and multivariable logistic regression analyses were performed to evaluate factors associated with in-hospital mortality. Receiver operator characteristic (ROC) curves and survival curves were plotted to evaluate their clinical utility.RESULTSThe counts of all T lymphocyte subsets were markedly lower in nonsurvivors than in survivors, especially CD8+ T cells. Among all tested cytokines, IL-6 was elevated most significantly, with an upward trend of more than 10-fold. Using multivariate logistic regression analysis, IL-6 levels of more than 20 pg/mL and CD8+ T cell counts of less than 165 cells/μL were found to be associated with in-hospital mortality after adjusting for confounding factors. Groups with IL-6 levels of more than 20 pg/mL and CD8+ T cell counts of less than 165 cells/μL had a higher percentage of older and male patients as well as a higher proportion of patients with comorbidities, ventilation, intensive care unit admission, shock, and death. Furthermore, the receiver operating curve of the model combining IL-6 (>20 pg/mL) and CD8+ T cell counts (<165 cells/μL) displayed a more favorable discrimination than that of the CURB-65 score. The Hosmer-Lemeshow test showed a good fit of the model, with no statistical significance.CONCLUSIONIL-6 (>20 pg/mL) and CD8+ T cell counts (<165 cells/μL) are 2 reliable prognostic indicators that accurately stratify patients into risk categories and predict COVID-19 mortality.FundingThis work was supported by funding from the National Natural Science Foundation of China (no. 81772477 and 81201848).

Keywords: Cytokines; Infectious disease; Pulmonology; T cells.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Area Under Curve
  • Betacoronavirus
  • CD8-Positive T-Lymphocytes*
  • COVID-19
  • Coronavirus Infections / blood
  • Coronavirus Infections / immunology*
  • Coronavirus Infections / mortality
  • Female
  • Hospital Mortality*
  • Humans
  • Interleukin-10 / immunology
  • Interleukin-6 / immunology*
  • Interleukin-8 / immunology
  • Logistic Models
  • Lymphocyte Count
  • Lymphopenia / blood
  • Lymphopenia / epidemiology
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Pandemics
  • Pneumonia, Viral / blood
  • Pneumonia, Viral / immunology*
  • Pneumonia, Viral / mortality
  • Prognosis
  • ROC Curve
  • Receptors, Interleukin-2 / immunology
  • Retrospective Studies
  • SARS-CoV-2
  • Tumor Necrosis Factor-alpha / immunology

Substances

  • CXCL8 protein, human
  • IL10 protein, human
  • IL6 protein, human
  • Interleukin-6
  • Interleukin-8
  • Receptors, Interleukin-2
  • TNF protein, human
  • Tumor Necrosis Factor-alpha
  • Interleukin-10