Persistent lymphopenia after diagnosis of COVID-19 predicts acute respiratory distress syndrome: A retrospective cohort study

Abstract

Background Lymphopenia is a marker of immunosuppression after severe coronavirus disease-2019 (COVID-19) which is characterized by acute respiratory distress syndrome (ARDS). This study aimed to evaluate the relationships between persistent lymphopenia and ARDS. Methods A retrospective cohort study of 125 patients with COVID-19 admitted to government-designated treatment center between 14 January 2020, and 20 March 2020 was conducted. We recorded all complete blood cell counts during the day 0th, 3rd, and 7th following the diagnosis of COVID-19. Patients were grouped based on the depression of the lymphocyte cell count, their return, or their failure to normal. The primary outcome was the occurrence of ARDS, and secondary outcomes included developing vital organ dysfunction and hospital lengths of stay. Results 17.6% (22/125) patients developed ARDS. The lymphocyte counts with ARDS and non-ARDS were 0.94 × 109/L, 1.20 × 109/L at admission, respectively ( p = 0.02). On the 3rd and 7th day, the median of lymphocyte count in ARDS was significantly lower than that of non-ARDS. Multivariable logistic regression, which was adjusting for potentially confounding factors (including age, comorbidities, and APACHE II score), showed that persistent lymphopenia within the 7th day was independently associated with ARDS (OR, 3.94 [95% CI, 1.26–12.33, p = 0.018). Further, patients with persistent lymphopenia had longer hospital lengths of stay ( p < 0.001). Conclusion The results showed persistent lymphopenia predicted ARDS after COVID-19. Further studies are needed to investigate whether immunostimulation of lymphocytes within 1 week can reduce ARDS occurrence in patients with COVID-19.

Epidemiological, clinical and laboratory profile of patients presenting with severe acute respiratory syndrome (SARS-CoV-2) in Ethiopia

“…However that, some of laboratory findings The current study inconsistent with the findings of other comparative studies [13,19,20] in that lymphopenia was more common and cardinal laboratory finding in COVID-19 patients than in patients without the disease [37,39]. Although many studies have shown that a low lymphocyte count may predict the severity of the COVID-19 [40,41], in the current study low lymphocyte counts did not predict the disease status, and this may be because of co-morbidities that could be associated with an increased risk of lymphopenia, such as hypertension and diabetes [42] which are really common co-morbidities in this study. As a result, significant difference may not be observed among patients with and without COVID-19 as the comparability of marked systemic increase of inflammatory mediators and cytokines which contribute to comorbid and COVID-19-associated lymphopenia.…”

Severe COVID-19-associated sepsis is different from classical sepsis induced by pulmonary infection with carbapenem-resistant klebsiella pneumonia (CrKP)

“…Meanwhile, the acquired immunosuppression was more severe, indicated by lower lymphocyte counts. 16 Moreover, the proportion of corticosteroid therapy and ECMO support in patients with COVID-19 was even higher, while the use of CRRT and invasive mechanical ventilation was lower, compared with CrKP patients. The hospitalized mortality, ICU and total length of hospital stay were also lower/shorter than that in patients with viral sepsis, and similar results were obtained after being adjusted for age, gender, and PaO 2 /FiO 2 .…”

Melatonin: Regulation of Viral Phase Separation and Epitranscriptomics in Post-Acute Sequelae of COVID-19

“…Lymphopenia and the depletion of T lymphocyte subsets were found in 98% (153/157) of patients infected by SARS-CoV in 2003 without any preexisting hematological disorders [ 372 ]. Correspondingly, patients infected by SARS-CoV-2 are associated with persistent lymphopenia [ 373 , 374 ] and functional exhaustion of lymphocytes [ 375 ]. COVID-19 disease progression is correlated with a nearly three-fold increased risk of severe COVID-19 (random effects model, OR = 2.99, 95% CI: 1.31–6.82) [ 376 ], while low lymphocyte counts in patients are deemed to be effective predictors of disease severity and hospitalization [ 377 , 378 ].…”