Document Type : Research articles
Authors
- Mohammad Hadi Karbalaie Niya 1
- Maryam Roham 2
- Ramin Ebrahimi 3
- Farshad Divsalar 4
- Sara Khodazadeh-asl 5
- Kiana Sohrabi 6
- Nilofar Sadat Kalaki 7
1 PhD in Virology, Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran. Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
2 MD, Infectious Diseases, Antimicrobial Research Center, Iran University of Medical Sciences, Tehran, Iran
3 MD, Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
4 MD, Infectious Diseases, Department of Infectious Diseases, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
5 MD, Infectious Diseases, Department of Infectious Diseases, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Tropical Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran
6 MD, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
7 MSc in Microbiology, Department of Virology, Pasteur Institute of Iran, Tehran, Iran
Abstract
Background: As COVID-19 severity and related death is a challenging issue, the protective effect and predictive value of lymphocyte count are critical. The present study investigated the importance of lymphopenia on disease severity and death rate.
Methods: This retrospective cross-sectional study was performed from April 2020 to June 2020 on a total of 300 patients with confirmed COVID-19 who attended the Firoozgar Hospital affiliated with the Iran University of Medical Sciences, Tehran, Iran. All of the COVID-19 patients referred to the hospital during the study period and met the inclusion criteria were enrolled and divided into two groups of lymphopenia (lymphocyte count less than 1.0x109/L) (n=138) and non-lymphopenia (n=162). All patient data from the medical records were acquired and utilized for statistical analysis.
Results: Of 300 patients 63.3% were male and 72% had underlying disease. The most common symptoms were dyspnea (50%), cough (41%), and lethargy (40%). Lymphopenia was associated with male gender (P=0.01). Additionally, mean age (P=0.02), ventilator need (P=0.03), and death (P=0.05) were significantly associated with lymphopenia compared to the non-lymphopenia group. The Lymphopenia group had lower levels of O2 saturation (P=0.04), AST (P=0.001), and ALT levels (P=0.02). Based on the chest CT scan results, there was a significant relationship between lymphopenia and the extent of pulmonary involvement (P=0.004)
Conclusion: Lymphopenia could clinically predict the severity of COVID-19. Lymphopenia was associated with male gender, older age, ventilator need, and death. Lymphopenia status had a significant relationship with reduced levels of O2 saturation, AST, ALT, and the extent of pulmonary involvement.
Keywords
- Jamilloux Y, Henry T, Belot A, Viel S, Fauter M, El Jammal T, et al. Should we stimulate or suppress immune responses in COVID-19? Cytokine and anti-cytokine interventions. Autoimmun Rev. 2020;19(7):102567. doi: 10.1016/j.autrev.2020.102567. [PubMed: 32376392].
- He S, Zhou C, Lu D, Yang H, Xu H, Wu G, et al. Relationship between chest CT manifestations and immune response in COVID-19 patients. Int J Infect Dis. 2020;98:125-9. doi: 10.1016/j.ijid.2020.06.059. [PubMed: 32574694].
- Asadollahi-Amin A, Ghiasvand F, Hasibi M, Seyedpour S, Barzegary A, Ghadimi F, et al. Patients with COVID‐19‐Associated Hematologic Abnormalities and the Potential Role of the Cytokine Storm: A Case Series Study. Vaccine Research. 2020;7(2):9-14. doi: 10.52547/vacres.7.2.9.
- Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The lancet. 2020;395(10223):497-506. doi: 10.1016/S0140-6736(20)30183-5. [PubMed: 31986264].
- Yang X, Yu Y, Xu J, Shu H, Liu H, Wu Y, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-81. doi: 10.1016/S2213-2600(20)30079-5. [PubMed: 32105632]
- Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020;46(5):846-8. doi: 10.1007/s00134-020-05991-x. [PubMed: 32125452].
- Jafarzadeh A, Jafarzadeh S, Nozari P, Mokhtari P, Nemati M. Lymphopenia an important immunological abnormality in patients with COVID‐19: possible mechanisms. Scand J Immunol. 2021;93(2):e12967. doi: 10.1111/sji.12967. [PubMed: 32875598].
- Liu J, Li H, Luo M, Liu J, Wu L, Lin X, et al. Lymphopenia predicted illness severity and recovery in patients with COVID-19: A single-center, retrospective study. PLoS One. 2020;15(11):e0241659. doi: 10.1371/journal.pone.0241659. [PubMed: 33206680].
- Zaboli E, Majidi H, Alizadeh‐Navaei R, Hedayatizadeh‐Omran A, Asgarian‐Omran H, Vahedi Larijani L, et al. Lymphopenia and lung complications in patients with coronavirus disease‐2019 (COVID‐19): A retrospective study based on clinical data. J Med Virol. 2021;93(9):5425-31. doi: 10.1002/jmv.27060. [PubMed: 33945642].
- Yin Y, Wunderink RG. MERS, SARS and other coronaviruses as causes of pneumonia. Respirology. 2018;23(2):130-7. doi: 10.1111/resp.13196. [PubMed: 29052924].
- Azhar EI, Lanini S, Ippolito G, Zumla A. The Middle East respiratory syndrome coronavirus–a continuing risk to global health security. Adv Exp Med Biol. 2017;972:49-60. doi: 10.1007/5584_2016_133. [PubMed: 27966107].
- Francone M, Iafrate F, Masci GM, Coco S, Cilia F, Manganaro L, et al. Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis. Eur Radiol. 2020;30(12):6808-17. doi: 10.1007/s00330-020-07033-y. [PubMed: 32623505].
- Wan S, Li M, Ye Z, Yang C, Cai Q, Duan S, et al. CT manifestations and clinical characteristics of 1115 patients with coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis. Acad Radiol. 2020;27(7):910-21. doi: 10.1016/j.acra.2020.04.033. [PubMed: 32505599].
- Saeed GA, Gaba W, Shah A, Al Helali AA, Raidullah E, Al Ali AB, et al. Correlation between chest CT severity scores and the clinical parameters of adult patients with COVID-19 pneumonia. Radiol Res Pract. 2021;2021:6697677. doi: 10.1155/2021/6697677. [PubMed: 33505722].
- Booth CM, Matukas LM, Tomlinson GA, Rachlis AR, Rose DB, Dwosh HA, et al. Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area. JAMA. 2003;289(21):2801-9. doi: 10.1001/jama.289.21.JOC30885. [PubMed: 12734147].
- Liu K, Fang YY, Deng Y, Liu W, Wang MF, Ma JP, et al. Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province. Chin Med J (Engl). 2020;133(9):1025-31. doi: 10.1097/CM9.0000000000000744. [PubMed: 32044814].
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