Clinical and immunologic features in severe and moderate Coronavirus Disease 2019.

By Guang Chen, Di Wu, W. Guo, Yong-Xiao Cao, Da Huang, Hongwu Wang, Taojiao Wang, Xiaoyun Zhang, Huilong Chen, Hai-jing Yu and 10 more. Journal of Clinical Investigation, 2020

2,450 citations recorded by the source corpus.

BACKGROUND Since December 2019, an outbreak of Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, and is now becoming a global threat. We aimed to delineate and compare the immunologic features of severe and moderate COVID-19. METHODS In this retrospective study, the clinical and immunologic characteristics of 21 patients (17 male and 4 female) with COVID-19 were analyzed. These patients were classified as severe (11 cases) and moderate (10 cases) according to the Guidelines released by the National Health Commission of China. RESULTS The median age of severe and moderate cases was 61.0 and 52.0 years, respectively. Common clinical manifestations included fever, cough and fatigue. Compared to moderate cases, severe cases more frequently had dyspnea, lymphopenia, and hypoalbuminemia, with higher levels of alanine aminotransferase, lactate dehydrogenase, C-reactive protein, ferritin and D-dimer as well as markedly higher levels of IL-2R, IL-6, IL-10, and TNF-α. Absolute number of T lymphocytes, CD4+T and CD8+T cells decreased in nearly all the patients, and were markedly lower in severe cases (294.0, 177.5 and 89.0 × 106/L) than moderate cases (640.5, 381.5 and 254.0 × 106/L). The expressions of IFN-γ by CD4+T cells tended to be lower in severe cases (14.1%) than moderate cases (22.8%). CONCLUSION The SARS-CoV-2 infection may affect primarily T lymphocytes particularly CD4+T and CD8+ T cells, resulting in decrease in numbers as well as IFN-γ production. These potential immunological markers may be of importance due to their correlation with disease severity in COVID-19.

Subfields: Immunology, Infectious Diseases

View Paper: https://www.semanticscholar.org/paper/a2b539a486c29d3b7d9b7a652ccd304a7223c3ae

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

In Immunology

In Infectious Diseases

Citations in the corpus

Aging in COVID-19: Vulnerability, immunity and intervention (2020, positive): “counts predict better clinical outcomes (Chen et al., 2020; Lagunas-Rangel and Chavez-Valencia, 2020; Qin et al., 2020; Wang et al., 2020a; Zhou et al., 2020a).”
Severe COVID-19 Is Marked by a Dysregulated Myeloid Cell Compartment (2020, positive): “After stimulation, cell-free supernatants were collected and tested for IL-1b, IFNg, and TNFa, respectively, using the cytokine bead assay Legend-Plex Mix&Match inflammation panel 1 kit (Biolegend, USA).”
Immune Response, Inflammation, and the Clinical Spectrum of COVID-19 (2020, background): “Changes in Circulating Cells Regarding cellular changes, most studies show that lymphopenia, although present in moderate infections, is more pronounced in severe COVID-19 (17, 108) and affects mainly T cells, including CD4 Th1 and Tregs, but particularly CD8 (17, 48, 108–110).”
Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection (2020, background): “In severe cases, elevated C-reactive protein (CRP), ferritin, d-dimers in addition to pro-inflammatory factors such as IL-6 and soluble CD25 (sC25), and an increase in intermediate (CD16+ CD14 +) monocytes have been reported [13, 14].”
The cytokine storm and COVID‐19 (2020, background): “Some studies have found that patients with severe COVID‐ 19 exhibit higher levels of IL‐2, IL‐6, IL‐7, IL‐10, IP‐10, MCP‐1, TNF‐α, macrophage inflammatory protein 1 alpha, and granulocyte‐CSF than patients with mild and moderate infections.(2,43,44) The fluctuations of these cytokines (eg, IL‐6, IL‐”
Early induction of functional SARS-CoV-2-specific T cells associates with rapid viral clearance and mild disease in COVID-19 patients (2021, background): “The illness (coronavirus disease 2019 [COVID-19]) resulting from SARS-CoV-2 infection is reported to be multifaceted with inflammation of the respiratory tract causing the leading symptoms of fever and dry cough (Chen et al., 2020).”
Comprehensive mapping of immune perturbations associated with severe COVID-19 (2020, background): “Days since onset of symptoms 27 (17-32) 9 (1-16) 9 (1-25)”