Utility of Monocyte Expression of HLA-DR versus T Lymphocyte Frequency in the Assessment of COVID-19 Outcome

Reham Hammad; Hend G Kotb; Gehan Abdel-Rahman Eldesoky; Alshaimaa Mohamed Mosaad; Asmaa M El-Nasser; Fatma El-Zahraa Abd El Hakam; Noha Abdel-Rahman Eldesoky; Alya Mashaal; Hesham Farhoud

doi:10.2147/IJGM.S359690

Utility of Monocyte Expression of HLA-DR versus T Lymphocyte Frequency in the Assessment of COVID-19 Outcome

Int J Gen Med. 2022 May 19:15:5073-5087. doi: 10.2147/IJGM.S359690. eCollection 2022.

Authors

Reham Hammad¹, Hend G Kotb², Gehan Abdel-Rahman Eldesoky³, Alshaimaa Mohamed Mosaad⁴, Asmaa M El-Nasser⁵, Fatma El-Zahraa Abd El Hakam⁶, Noha Abdel-Rahman Eldesoky⁷, Alya Mashaal⁸, Hesham Farhoud⁹

Affiliations

¹ Clinical Pathology Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt.
² Internal Medicine Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt.
³ Anesthesia, Intensive Care and Pain Management Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt.
⁴ Hepatogastroenterology and Infectious Diseases Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt.
⁵ Medical Microbiology & Immunology Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt.
⁶ Pharmacology Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt.
⁷ Biochemistry and Molecular Biology Department, Faculty of Pharmacy (for Girls), Al-Azhar University, Cairo, Egypt.
⁸ Immunology, Zoology & Entomology Department, Faculty of Science (for Girls), Al-Azhar University, Cairo, Egypt.
⁹ Orthopedic Surgery Department, Former Dean of Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt.

Abstract

Background: Dysregulated immunity is a hallmark of SARS-CoV-2 infection. Immune suppression is indicated by low monocyte expression of human leukocyte antigen D-related (mHLA-DR). T cells are important antiviral cells. We aimed to assess the role of mHLA-DR and T lymphocyte frequency in predicting COVID-19 severity.

Patients and methods: This cross-sectional study enrolled 97 SARS-CoV-2 positive patients, including mild to moderate (n = 49) and severe cases admitted to intensive care unit (ICU) (n = 48). These ICU cases were further subdivided into survivors (n = 35) and non-survivors (n = 13).

Results: Severe cases had a significant decrease in the mHLA-DR mean fluorescence intensity (MFI) and T lymphocyte percentage compared to mild to moderate cases (P<0.001). Non-survivors had a lower T lymphocyte percentage (P=0.004) than survivors. The mHLA-DR MFI and T lymphocyte percentage correlated with oxygen saturation (r=0.632, P<0.001) and (r=0.669, P<0.001), respectively. According to the ROC curves, mHLA-DR MFI, at a cutoff of 143 and an AUC of 0.9, is a reliable biomarker for distinguishing severe COVID-19 cases, with 89.6% sensitivity and 81.6% specificity, while T lymphocyte frequency had 81.3% sensitivity and 81.6% specificity at a cutoff of 54.4% and an AUC of 0.9. The T lymphocyte percentage as a predictor of ICU survival at a cutoff of 38.995% exhibited 100% sensitivity and 57.1% specificity. According to multivariate regression analysis, reduced mHLA-DR MFI and T lymphocyte percentage are independent predictors of COVID-19 severity (OR = 0.976, 95% CI: 0.955-0.997, P = 0.025) and (OR = 0.849, 95% CI: 0.741-0.972, P = 0.018), respectively.

Conclusion: Reduced mHLA-DR expression and T-lymphocyte percentage are independent predictors of COVID-19 severity. Oxygen saturation percentage is correlated with mHLA-DR MFI and T lymphocyte frequency. The T lymphocyte frequency is a proposed predictor of COVID-19 survival in ICU admitted patients.

Keywords: COVID-19 monitoring; COVID-19 patients’ stratification; COVID-19 severity discriminators; T cell lymphopenia; mHLA-DR.