IL-6 and CD8+ T cell counts combined are an early predictor of in-hospital mortality of patients with COVID-19

Abstract

BACKGROUND. Fatal cases of COVID-19 are increasing globally. We retrospectively investigated the potential of immunologic parameters as early predictors of COVID-19. METHODS. A total of 1018 patients with confirmed COVID-19 were enrolled in our 2-center retrospective study. Clinical feature, laboratory test, immunological test, radiological findings, and outcomes data were collected. Univariate and multivariable logistic regression analyses were performed to evaluate factors associated with in-hospital mortality. Receiver operator characteristic (ROC) curves and survival curves were plotted to evaluate their clinical utility. RESULTS. The counts of all T lymphocyte subsets were markedly lower in nonsurvivors than in survivors, especially CD8 + T cells. Among all tested cytokines, IL-6 was elevated most significantly, with an upward trend of more than 10-fold. Using multivariate logistic regression analysis, IL-6 levels of more than 20 pg/mL and CD8 + T cell counts of less than 165 cells/μL were found to be associated with in-hospital mortality after adjusting for confounding factors. Groups with IL-6 levels of more than 20 pg/mL and CD8 + T cell counts of less than 165 cells/μL had a higher percentage of older and male patients as well as a higher proportion of patients with comorbidities, ventilation, intensive care unit admission, shock, and death. Furthermore, the receiver operating curve of the model combining IL-6 (>20 pg/mL) and CD8 + T cell counts (<165 cells/μL) displayed a more favorable discrimination than that of the CURB-65 score. The Hosmer-Lemeshow test showed a good fit of the model, with no statistical significance. CONCLUSION. IL-6 (>20 pg/mL) and CD8 + T cell counts (<165 cells/μL) are 2 reliable prognostic indicators that accurately stratify patients into risk categories and predict COVID-19 mortality.

Prevalence and Associated Risk Factors of Mortality Among COVID-19 Patients: A Meta-Analysis

“…Among the Asian region, the highest mortality was found in China and South Korea [47,66]. A large variation of prevalence of mortality was found among the Chinese population [13,27,32,36,41,42,47].…”

Circulating Mitochondrial DNA is an Early Indicator of Severe Illness and Mortality from COVID-19

“…Multiple clinically established biomarkers such as LDH, Ferritin, CRP and D-dimers are currently being evaluated to assess the risk of clinical deterioration from a COVID-19 diagnosis (Cummings et al, 2020;Luo et al, 2020;McElvaney et al, 2020;Messner et al, 2020;Song et al, 2020;Wu et al, 2020). However, as products of gene expression in response to both acute and chronic stimuli they tend to be largely non-specific measures of systemic inflammation with the exception of LDH, a marker of cell death.…”

Association of Peripheral Lymphocyte and the Subset Levels With the Progression and Mortality of COVID-19: A Systematic Review and Meta-Analysis

“…The search strategy identified 7,385 records: 6,528 from PubMed, 465 from CNKI, 322 from Wangfan, and 70 from other sources (Figure 1). After excluding duplicated and irrelevant records, 16 studies were included in this meta-analysis with a total of 10,624 COVID-19 cases ( Table 1) (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Thirteen studies derived from China, while one study came from the USA, one from Spain and one from India.…”