Clinical and Autoimmune Characteristics of Severe and Critical Cases of COVID‐19

Abstract

In this study we report on the clinical and autoimmune characteristics of severe and critical novel coronavirus pneumonia caused by severe acute respiratory syndrome-associated coronavirus 2 (SARS-CoV-2). The clinical, autoimmune, and laboratory characteristics of 21 patients who had laboratory-confirmed severe and critical cases of coronavirus disease 2019 (COVID-19) from the intensive care unit of the Huangshi Central Hospital, Hubei Province, China, were investigated. A total of 21 patients (13 men and 8 women), including 8 (38.1%) severe cases and 13 (61.9%) critical cases, were enrolled. Cough (90.5%) and fever (81.0%) were the dominant symptoms, and most patients (76.2%) had at least one coexisting disorder on admission. The most common characteristics on chest computed tomography were ground-glass opacity (100%) and bilateral patchy shadowing (76.2%). The most common findings on laboratory measurement were lymphocytopenia (85.7%) and elevated levels of C-reactive protein (94.7%) and interleukin-6 (89.5%). The prevalence of anti-52 kDa SSA/Ro antibody, anti-60 kDa SSA/Ro antibody, and antinuclear antibody was 20%, 25%, and 50%, respectively. We also retrospectively analyzed the clinical and laboratory data from 21 severe and critical cases of COVID-19. Autoimmune phenomena exist in COVID-19 subjects, and the present results provide the rationale for a strategy of preventing immune dysfunction and optimal immunosuppressive therapy.

WITHDRAWN: The Association of HScore Parameters with Severe COVID-19: a Systematic Review and Meta-Analysis

“…For lymphocyte, although one of the studies [19] showed that patients with sCOVID-19 had higher lymphocyte count compared to non-severe COVID-19 ones (MD = 0.01 [-0.34,0.36]), the pooled results of thirteen studies [15,16,18,19,[22][23][24][25][26][28][29][30]32] showed that lymphocyte count in patients with sCOVID-19 was signi cantly lower compared to non-severe COVID-19 patients (MD = -0.38 [-0.47,-0.29], p-value < 0.0001) ( Fig 2B). In twelve studies [15,18,19,[22][23][24][25][26][28][29][30]32], patients with severe conditions had signi cantly higher neutrophil count than those with non-severe complications (MD = 2.01 [1.22,2.80], p-value = 0.005) ( Fig 2C). The results of xed-effects meta-analysis on the ten studies [15,16,18,19,[22][23][24]26,28,30] showed that platelet count in patients with sCOVID-19 was signi cantly lower compared to patients with non-severe COVID-19 (MD = -11.7 [-23.03,-0.38], p-value = 0.042) ( Fig 2D).…”

“…Based on the described search strategy, a total of 26151 studies were identi ed in the three searched online databases. Following the removal of duplicates and screening all records, 18 studies meeting the predetermined eligibility criteria were imported in the meta-analysis [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. The article number and reason for exclusion in each screening steps are depicted in Fig 1. Accumulatively, 2459 patients were included in the quantitative analysis, among which 710 patients were in severe/critical condition, and the rest (1737 cases) classi ed as mild/moderate disease.…”

“…There was no heterogeneity for hemoglobin and platelet variables and the xed-effects model was performed (I 2 = 0%, p-value = 0.52 and I 2 = 0%, p-value = 0.51, respectively). The results of randomeffects meta-analysis showed that in twelve studies [15,16,18,19,[22][23][24]26,[28][29][30]32], patients with sCOVID-19 had higher WBC compared to patients with non-severe COVID-19 which it was signi cant (MD = 1.23 [0.29,2.17], p-value = 0.01) (Fig 2A). For lymphocyte, although one of the studies [19] showed that patients with sCOVID-19 had higher lymphocyte count compared to non-severe COVID-19 ones (MD = 0.01 [-0.34,0.36]), the pooled results of thirteen studies [15,16,18,19,[22][23][24][25][26][28][29][30]32] showed that lymphocyte count in patients with sCOVID-19 was signi cantly lower compared to non-severe COVID-19 patients (MD = -0.38 [-0.47,-0.29], p-value < 0.0001) ( Fig 2B).…”

“…The results of randomeffects meta-analysis showed that in twelve studies [15,16,18,19,[22][23][24]26,[28][29][30]32], patients with sCOVID-19 had higher WBC compared to patients with non-severe COVID-19 which it was signi cant (MD = 1.23 [0.29,2.17], p-value = 0.01) (Fig 2A). For lymphocyte, although one of the studies [19] showed that patients with sCOVID-19 had higher lymphocyte count compared to non-severe COVID-19 ones (MD = 0.01 [-0.34,0.36]), the pooled results of thirteen studies [15,16,18,19,[22][23][24][25][26][28][29][30]32] showed that lymphocyte count in patients with sCOVID-19 was signi cantly lower compared to non-severe COVID-19 patients (MD = -0.38 [-0.47,-0.29], p-value < 0.0001) ( Fig 2B). In twelve studies [15,18,19,[22][23][24][25][26][28][29][30]32], patients with severe conditions had signi cantly higher neutrophil count than those with non-severe complications (MD = 2.01 [1.22,2.80], p-value = 0.005) ( Fig 2C).…”

“…In twelve studies [15,18,19,[22][23][24][25][26][28][29][30]32], patients with severe conditions had signi cantly higher neutrophil count than those with non-severe complications (MD = 2.01 [1.22,2.80], p-value = 0.005) ( Fig 2C). The results of xed-effects meta-analysis on the ten studies [15,16,18,19,[22][23][24]26,28,30] showed that platelet count in patients with sCOVID-19 was signi cantly lower compared to patients with non-severe COVID-19 (MD = -11.7 [-23.03,-0.38], p-value = 0.042) ( Fig 2D). Finally, in eleven studies [15,16,18,19,[22][23][24]26,28,30,32] those categorized as severe patients had lower hemoglobin compared to non-severe patients which it was signi cant (MD = -4.95 [-7.48,-2.41], p-value = 0.0001) (Fig 2E).…”