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pmid33734627      Isr+Med+Assoc+J 2021 ; 23 (3): 153-159
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  • Poor Survival in COVID-19 Associated with Lymphopenia and Higher Neutrophile-Lymphocyte Ratio #MMPMID33734627
  • Montiel-Cervantes LA; Medina G; Pilar Cruz-Dominguez M; Perez-Tapia SM; Jimenez-Martinez MC; Arrieta-Oliva HI; Carballo-Uicab G; Lopez-Pelcastre L; Camacho-Sandoval R
  • Isr Med Assoc J 2021[Mar]; 23 (3): 153-159 PMID33734627show ga
  • BACKGROUND: Immune cell counts in blood in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection may be useful prognostic biomarkers of disease severity, mortality, and response to treatment. OBJECTIVES: To analyze sub-populations of lymphocytes at hospital admission in survivors and deceased from severe pneumonia due to coronavirus disease-2019 (COVID-19). METHODS: We conducted a cross-sectional study of healthcare workers confirmed with SARS-CoV-2 in convalescents (control group) and healthy controls (HC) diagnosed with severe COVID-19. Serum samples were taken at hospital admission and after recovery. Serum samples >/= 25 days after onset of symptoms were analyzed for lymphocyte subpopulations through flow cytometry. Descriptive statistics, Kruskall-Wallis test, receiver operating characteristic curve, calculation of sensitivity, specificity, predictive values, and Kaplan-Meier analysis were performed. RESULTS: We included 337 patients: 120 HC, 127 convalescents, and 90 severe COVID-19 disease patients (50 survivors, 40 deceased). For T cells, total lymphocytes >/= 800/muL, CD3+ >/= 400/muL, CD4+ >/= 180/muL, CD8+ >/= 150/muL, B cells CD19+ >/= 80/muL, and NK >/= 34/muL subsets were associated with survival in severe COVID-19 disease patients. All subtypes of lymphocytes had higher concentrations in survivors than deceased, but similar between HC and convalescents. Leukocytes >/= 10.150/muL or neutrophils >/= 10,000/muL were associated with increased mortality. The neutrophil-to-lymphocyte ratio (NLR) >/= 8.5 increased the probability of death in severe COVID-19 (odds ratio 11.68). CONCLUSIONS: Total lymphocytes; NLR; and levels of CD3+, CD4+, CD8+, and NK cells are useful as biomarkers of survival or mortality in severe COVID-19 disease and commonly reach normal levels in convalescents.
  • |*COVID-19/blood/diagnosis/mortality/therapy[MESH]
  • |*Lymphopenia/blood/diagnosis/etiology[MESH]
  • |Biomarkers/blood[MESH]
  • |CD4-Positive T-Lymphocytes/*pathology[MESH]
  • |CD8-Positive T-Lymphocytes/*pathology[MESH]
  • |Correlation of Data[MESH]
  • |Cross-Sectional Studies[MESH]
  • |Female[MESH]
  • |Humans[MESH]
  • |Kaplan-Meier Estimate[MESH]
  • |Killer Cells, Natural/pathology[MESH]
  • |Leukocyte Count/methods[MESH]
  • |Male[MESH]
  • |Mexico/epidemiology[MESH]
  • |Middle Aged[MESH]
  • |Mortality[MESH]
  • |Neutrophils/*pathology[MESH]
  • |Predictive Value of Tests[MESH]


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