Lymphocyte subset alterations with disease severity, imaging manifestation, and delayed hospitalization in COVID-19 patients

  1. Daxian Wu
  2. Xiaoping Wu
  3. Jiansheng Huang
  4. Qunfang Rao
  5. Qi Zhang
  6. Wenfeng Zhang

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Abstract

Background

COVID-19 continuously threated public health heavily. Present study aimed to investigate the lymphocyte subset alterations with disease severity, imaging manifestation, and delayed hospitalization in COVID-19 patients.

Methods

Lymphocyte subsets was classified using flow cytometry with peripheral blood collected from 106 patients.

Results

Multivariate logistic regression showed that chest tightness, lymphocyte count, and γ-glutamyl transpeptidase were the independent predictors for severe COVID-19. The T cell, CD4 + T cell and B cell counts in severe patients were significantly lower than that in mild patients ( p  = 0.004, 0.003 and 0.046, respectively). Only the T cell count was gradually decreased with the increase of infiltrated quadrants of lesions in computed tomography (CT) ( p  = 0.043). The T cell, CD4 + T cell, and CD8 + T cell counts were gradually decreased with the increase of infiltrated area of the maximum lesion in CT ( p  = 0.002, 0.003, 0.028; respectively). For severe patients, the counts of T cell, CD4 + T cell, CD8 + T cell gradually decreased with the increased delayed hospitalization ( p  = 0.001, 0.03, and <  0.001, respectively). The proportions of T cell, CD8 + T cell gradually decreased with the increased delayed hospitalization (both p  <  0.001), but the proportions of NK cell, B cell gradually increased with the increased delayed hospitalization ( p  = 0.007, and 0.002, respectively). For mild patients, only the NK cell count was gradually decreased with the increased delayed hospitalization ( p  = 0.012).

Conclusion

T lymphocyte and its subset negatively correlated with disease severity, CT manifestation and delayed hospitalization. The counts of lymphocyte subset were changed more profound than their proportions.

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  1. Version published to 10.1186/s12879-021-06354-7
  2. ScreenIT

    SciScore for 10.1101/2020.08.25.20181321: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: All procedures followed were in accordance with the Ethics Committees of the First Affiliated Hospital, Nanchang University, and with the Helsinki Declaration of 1975, as revised in 2000.
    Consent: Informed consent was obtained from all patients for being included in the study.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Lymphocyte subsets was performed by BD FACSCanto™ II Flow Cytometer (BD Biosciences, Shanghai, China).
    BD FACSCanto™
    suggested: None
    Statistics: Statistical analysis was performed with SPSS 25.0 (SPSS, Inc., Chicago, USA) and MedCalc (MedCalc Software Ltd, Ostend, Belgium).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)
    MedCalc
    suggested: (MedCalc, RRID:SCR_015044)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There were several limitations in this study. First, the alteration of CD4+ T cell subsets was not investigated, although CD4+ T cell was demonstrated to be mainstay of immunity response to SARS-CoV-2 infection. Second, only 3 cases with TOH more than 14 days (TOH was 15, 15, and 16 days, respectively), the lymphocyte subset alterations of convalescence of COVID-19 patients was not seen in this study. More studies including patients with TOH more than 14 days need to investigate to observe lymphocyte subset alterations in whole natural history of the disease. In conclusion, present study revealed independent predictors for severe COVID-19 and found CD4+ T cell was mainstay of immunity response to SARS-CoV-2 infection. Total lymphocyte, T cell and CD4+ T cell counts negatively correlated with disease severity, CT manifestation and delayed hospitalization. We believe these findings would provide some new insights in management of COVID-19.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • No funding statement was detected.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.08.25.20181321v1 on medRxiv