Clinical characteristics and predictive value of lower CD4+T cell level in patients with moderate and severe COVID-19: a multicenter retrospective study.

Abstract

BACKGROUND:

In December 2019, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, Hubei, China. Moreover, it has become a global pandemic. This is of great value in describing the clinical symptoms of COVID-19 patients in detail and looking for markers which are significant to predict the prognosis of COVID-19 patients.

METHODS:

In this multicenter, retrospective study, 476 patients with COVID-19 were enrolled from a consecutive series. After screening, a total of 395 patients were included in this study. All-cause death was the primary endpoint. All patients were followed up from admission till discharge or death.

RESULTS:

The main symptoms observed in the study included fever on admission, cough, fatigue, and shortness of breath. The most common comorbidities were hypertension and diabetes mellitus. Patients with lower CD4+T cell level were older and more often male compared to those with higher CD4+T cell level. Reduced CD8+T cell level was an indicator of the severity of COVID-19. Both decreased CD4+T [HR:13.659; 95%CI: 3.235-57.671] and CD8+T [HR: 10.883; 95%CI: 3.277-36.145] cell levels were associated with in-hospital death in COVID-19 patients, but only the decrease of CD4+T cell level was an independent predictor of in-hospital death in COVID-19 patients.

CONCLUSIONS:

Reductions in lymphocytes and lymphocyte subsets were common in COVID-19 patients, especially in severe cases of COVID-19. It was the CD8+T cell level, not the CD4+T cell level, that reflected the severity of the patient's disease. Only reduced CD4+T cell level was independently associated with increased in-hospital death in COVID-19 patients.

TRIAL REGISTRATION:

Prognostic Factors of Patients With COVID-19, NCT04292964 . Registered 03 March 2020. Retrospectively registered.

• Authors: Xue-Song Wen, Dan Jiang, Lei Gao, Jian-Zhong Zhou, Jun Xiao, Xiao-Cheng Cheng, Bin He, Yue Chen, Peng Lei, Xiao-Wei Tan, Shu Qin, Dong-Ying Zhang
• Journal: BMC infectious diseases (BMC Infect Dis) Vol. 21 Issue 1 Pg. 57 (Jan 12 2021) ISSN: 1471-2334 [Electronic] England
• PMID: 33435865 (Publication Type: Journal Article, Multicenter Study, Observational Study)

Topics

• Adult
• Aged
• CD4-Positive T-Lymphocytes (cytology)
• CD8-Positive T-Lymphocytes (cytology)
• COVID-19 (blood, diagnosis, mortality, therapy)
• Comorbidity
• Female
• Follow-Up Studies
• Hospitalization
• Humans
• Lymphocyte Count
• Male
• Middle Aged
• Pandemics
• Patient Discharge
• Prognosis
• Retrospective Studies
• SARS-CoV-2 (genetics, immunology)