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Clinical Characteristics and Immune Responses of 137 Deceased Patients With COVID-19: A Retrospective Study.
Front Cell Infect Microbiol. 2020; 10:595333.FC

Abstract

Objective

This study aimed to evaluate the factors associated with death in patients with coronavirus disease 2019 by clarifying the clinical characteristics and immune responses.

Methods

The clinical characteristics and laboratory findings, including cytokine and lymphocyte subsets, were obtained from the electronic medical records of patients in Wuhan Tongji Hospital.

Results

This study included 836 patients with confirmed COVID-19. In total, 699 (83.6%) were cured and discharged, and 137 (16.4%) died. Our analysis revealed that age ≥ 65 years, male sex, malignancy, chronic obstructive pulmonary disease, dyspnea, dizziness, respiratory rate > 20 bpm, heart rate > 100 bpm, systolic blood pressure < 90 mmHg, neutrophils > 6.3×109/L, lymphopenia, thrombocytopenia, D-dimer ≥ 0.5 mg/L, lactate dehydrogenase > 250 U/L, aspartate aminotransferase > 40 U/L, total bilirubin > 26 μmol/L, albumin < 35 g/L, blood urea nitrogen > 9.5 mmol/L, estimated glomerular filtration rate < 90 ml/min/1.73, elevated cardiac troponin I, N-terminal pro-brain natriuretic peptide ≥ 900 pg/ml, C-reactive protein ≥ 25 mg/L, procalcitonin ≥ 0.05 ng/ml and ferritin > 400 μg/L were associated with death in patients with COVID-19. The multivariate logistic regression analysis revealed that an estimated glomerular filtration rate < 90 ml/min/1.73, elevated cardiac troponin I, C-reactive protein ≥ 25 mg/L and procalcitonin ≥ 0.05 ng/ml were predictive of mortality. Regarding immune responses, IL-2R, IL-6, IL-8, IL-10, and TNFα were remarkably higher in the deceased group at admission, and the levels of IL-2R, IL-6, IL-8, IL-10, and TNFα in the deceased group showed a rapid increase; the dynamics of these cytokines were highly consistent with disease deterioration. Lymphocyte subset analysis revealed that the deceased patients showed significant decreases in lymphocyte counts, especially helper T cells, suppressor T cells and NK cells.

Conclusions

This study identified that an estimated glomerular filtration rate < 90 ml/min/1.73, elevated cardiac troponin I, C-reactive protein ≥ 25 mg/L and procalcitonin ≥ 0.05 ng/ml were predictors of mortality in COVID-19 patients. Elevated cytokine levels and a continued increasing trend, including in IL-2R, IL-6, IL-8, IL-10 and TNFα, and a decrease in lymphocyte subsets, especially helper T cells, suppressor T cells and NK cells, were associated with a poor prognosis.

Authors+Show Affiliations

Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China.School of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China. Department of Occupational Disease, The Second Affiliated Hospital of Shandong University of TCM, Jinan, China.Nuclear Medicine of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33365277

Citation

Cui, Ning, et al. "Clinical Characteristics and Immune Responses of 137 Deceased Patients With COVID-19: a Retrospective Study." Frontiers in Cellular and Infection Microbiology, vol. 10, 2020, p. 595333.
Cui N, Yan R, Qin C, et al. Clinical Characteristics and Immune Responses of 137 Deceased Patients With COVID-19: A Retrospective Study. Front Cell Infect Microbiol. 2020;10:595333.
Cui, N., Yan, R., Qin, C., & Zhao, J. (2020). Clinical Characteristics and Immune Responses of 137 Deceased Patients With COVID-19: A Retrospective Study. Frontiers in Cellular and Infection Microbiology, 10, 595333. https://doi.org/10.3389/fcimb.2020.595333
Cui N, et al. Clinical Characteristics and Immune Responses of 137 Deceased Patients With COVID-19: a Retrospective Study. Front Cell Infect Microbiol. 2020;10:595333. PubMed PMID: 33365277.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical Characteristics and Immune Responses of 137 Deceased Patients With COVID-19: A Retrospective Study. AU - Cui,Ning, AU - Yan,Rongdi, AU - Qin,Chunyuan, AU - Zhao,Jingming, Y1 - 2020/12/07/ PY - 2020/08/16/received PY - 2020/11/11/accepted PY - 2020/12/28/entrez PY - 2020/12/29/pubmed PY - 2021/1/12/medline KW - COVID-19 KW - cytokines KW - immune responses KW - lymphocyte subset KW - mortality SP - 595333 EP - 595333 JF - Frontiers in cellular and infection microbiology JO - Front Cell Infect Microbiol VL - 10 N2 - Objective: This study aimed to evaluate the factors associated with death in patients with coronavirus disease 2019 by clarifying the clinical characteristics and immune responses. Methods: The clinical characteristics and laboratory findings, including cytokine and lymphocyte subsets, were obtained from the electronic medical records of patients in Wuhan Tongji Hospital. Results: This study included 836 patients with confirmed COVID-19. In total, 699 (83.6%) were cured and discharged, and 137 (16.4%) died. Our analysis revealed that age ≥ 65 years, male sex, malignancy, chronic obstructive pulmonary disease, dyspnea, dizziness, respiratory rate > 20 bpm, heart rate > 100 bpm, systolic blood pressure < 90 mmHg, neutrophils > 6.3×109/L, lymphopenia, thrombocytopenia, D-dimer ≥ 0.5 mg/L, lactate dehydrogenase > 250 U/L, aspartate aminotransferase > 40 U/L, total bilirubin > 26 μmol/L, albumin < 35 g/L, blood urea nitrogen > 9.5 mmol/L, estimated glomerular filtration rate < 90 ml/min/1.73, elevated cardiac troponin I, N-terminal pro-brain natriuretic peptide ≥ 900 pg/ml, C-reactive protein ≥ 25 mg/L, procalcitonin ≥ 0.05 ng/ml and ferritin > 400 μg/L were associated with death in patients with COVID-19. The multivariate logistic regression analysis revealed that an estimated glomerular filtration rate < 90 ml/min/1.73, elevated cardiac troponin I, C-reactive protein ≥ 25 mg/L and procalcitonin ≥ 0.05 ng/ml were predictive of mortality. Regarding immune responses, IL-2R, IL-6, IL-8, IL-10, and TNFα were remarkably higher in the deceased group at admission, and the levels of IL-2R, IL-6, IL-8, IL-10, and TNFα in the deceased group showed a rapid increase; the dynamics of these cytokines were highly consistent with disease deterioration. Lymphocyte subset analysis revealed that the deceased patients showed significant decreases in lymphocyte counts, especially helper T cells, suppressor T cells and NK cells. Conclusions: This study identified that an estimated glomerular filtration rate < 90 ml/min/1.73, elevated cardiac troponin I, C-reactive protein ≥ 25 mg/L and procalcitonin ≥ 0.05 ng/ml were predictors of mortality in COVID-19 patients. Elevated cytokine levels and a continued increasing trend, including in IL-2R, IL-6, IL-8, IL-10 and TNFα, and a decrease in lymphocyte subsets, especially helper T cells, suppressor T cells and NK cells, were associated with a poor prognosis. SN - 2235-2988 UR - https://www.unboundmedicine.com/medline/citation/33365277/Clinical_Characteristics_and_Immune_Responses_of_137_Deceased_Patients_With_COVID_19:_A_Retrospective_Study_ L2 - https://doi.org/10.3389/fcimb.2020.595333 DB - PRIME DP - Unbound Medicine ER -