Lymphopenia as a Biological Predictor of Outcomes in COVID-19 Patients: A Nationwide Cohort Study

Abstract

We aimed to identify whether lymphopenia is a reliable prognostic marker for COVID-19. Using data derived from a Korean nationwide longitudinal cohort of 5628 COVID-19 patients, we identified propensity-matched cohorts (n = 770) with group I of severe lymphopenia (absolute lymphocyte counts [ALC]: <500/mm3, n = 110), group II of mild-to-moderate lymphopenia (ALC: ≥500–<1000/mm3, n = 330), and group III, no lymphopenia (ALC: ≥1000/mm3, n = 330). A significantly higher mortality rate was associated with lymphopenia severity: 40% in group I, 22.7% in group II, and 13.0% in group III (p < 0.001). At 28 days, the estimated inferior overall survival associated with intensified lymphopenia: 62.7% in group I, 79.9% in group II, and 89.0% in group III (p < 0.001). Lymphopenia contributed significantly toward a greater need for interventions in all groups but at varying degrees: requirements of invasive ventilation, intensive oxygen supply, or adequate oxygen supply, respectively (p < 0.001). The lymphopenia intensity was independently associated with higher COVID-19 mortality in multivariable analysis; adjusted odds ratios of 5.63 (95% CI, 3.0–10.72), and 2.47 (95% CI, 1.5–4.13) for group I and group II, respectively. Lymphopenia and its severity levels may serve as reliable predictive factors for COVID-19 clinical outcomes; thus, lymphopenia may provide the prognostic granularity required for clinical use in the management of patients with COVID-19.

Mortality of patients with solid and haematological cancers presenting with symptoms of COVID-19 with vs without detectable SARS-COV-2: a French nationwide prospective cohort study

“…With 16% death rate at day 28, the death rate is significantly lower in this group than in patients with documented SARS-COV-2 RT-PCR+; however, this death rate at day 28 is higher than standard population of cancer patients. 28 , 29 The current results confirm observations reported in our previous single-centre study. 18 In this patient population, death is considered to be mostly (>50%) related to the underlying malignancy as per investigators' assessment.…”

Viral Load and Patterns of SARS-CoV-2 Dissemination to the Lungs, Mediastinal Lymph Nodes, and Spleen of Patients with COVID-19 Associated Lymphopenia

“…According to several studies, lymphopenia occurs in 80% of patients with mild and 96% severe COVID-19 and is a prognostic marker of poor disease outcome [ 5 , 6 , 7 , 35 ]. However, the pathogenesis of lymphopenia in COVID-19 could have complex etiology and may include more than 10 putative mechanisms.…”

“…However, the pathogenesis of lymphopenia in COVID-19 could have complex etiology and may include more than 10 putative mechanisms. In particular, the development of lymphopenia in patients with COVID-19 could result from extrapulmonary dissemination and the direct effect of SARS-CoV-2 particles on the tissues of the mediastinal lymph nodes, which filter lymph flowing from the lung primary inflammatory focus, and spleen, as a significant human lymphoid organ [ 9 , 10 , 11 , 35 ].…”

The 15-Months Clinical Experience of SARS-CoV-2: A Literature Review of Therapies and Adjuvants

“…A recent retrospective study evaluated an antiviral administration in 21 subjects affected by COVID-19 for a week who reported persistent fever and worsening of CT tomography evidence and hypoxia; the study reported a potential therapeutic efficacy of tocilizumab for this class of subject. Indeed, after treatment, in addition to the improvement of body temperature, respiratory function, imaging, and lymphopenia improved in most of the patients, with a normalization of inflammatory markers without a significant adverse event [128]. Based on this observation, a multicenter, single-arm, open-label, phase 2 study is currently ongoing but, as with the other drugs discussed here, larger trials are required with appropriate controls before science-based recommendations on use can be made [140].…”