The Immune, Inflammatory and Hematological Response in COVID-19 Patients, According to the Severity of the Disease

Abstract

Introduction: The aim of this study was to evaluate the immune and inflammatory responses in COVID-19 patients by dosing specific IgM and IgG total antibodies and interleukin 6, correlating them with the hematological and biochemical blood parameters and comparing them by the form of the disease. Materials and methods: One hundred twenty-five patients with polymerase chain reaction-confirmed COVID-19, hospitalized between 15.03.2020 and 1.07.2020 in the Clinical Hospital of Infectious Diseases “Sf. Parascheva” Iaşi, were tested by chemiluminescence for the presence of anti-SARS-CoV-2 IgM and IgG and IL-6 in the serum. The results were correlated with the results of the CBC count and serum biochemical parameters detected on the admission day. The patients presented different forms of the disease (asymptomatic, mild, moderate, severe, and critical) according to World Health Organization (WHO) criteria for the clinical management of COVID-19. Results: The amplitude of the immune response was directly correlated with the form of the disease. In the asymptomatic/mild form patients, the IL-6 and CRP concentrations were significantly higher and eosinophil count was significantly lower compared with the reference interval. In the moderate form, the concentrations of IL-6, CRP, and IgG were significantly higher, compared with the reference interval, while eosinophil count and eGFR were significantly lower. In severe/critical COVID-19 patients, IL-6, CRP, NLR, PLR, glucose, AST, urea, creatinine, and eGFR were significantly higher compared with the reference interval, while eosinophil count was significantly lower. IL-6 boosted in all forms of COVID-19, with a major increase in severe and critical patients. IL-6, neutrophil count, % neutrophils, NLR, PLR, CRP, AST, and urea increased with the severity of the SARS-CoV-2 infection, and the lymphocyte count, % lymphocytes, eosinophil count, % eosinophils, and hemoglobin decreased with the increased severity of COVID-19. Conclusions: The amplitude and the moment of appearance of the immune response depended on the form of the disease. IgM generally occurred in the first 14 days of illness, and IgG appeared beginning with the second week of disease. IgG titer increased rapidly until the fourth week of disease and decreased slowly after 4 weeks. The amplitudes of all the tested inflammatory and serological markers depended on the COVID-19 form, increasing somewhat in the moderate forms and even more in the critical ones. The lymphocyte and eosinophil count are able to predict the risk of severe COVID-19.

Lymphocyte-to-C-Reactive Protein (LCR) Ratio Is Not Accurate to Predict Severity and Mortality in Patients with COVID-19 Admitted to the ED

“…Other hematological ratios have been studied such as PLR, NLR or SSI since the beginning of the pandemic [ 28 , 29 ]. The value of the LCR should probably be coupled with other markers in a multi-marker approach or in a combined severity prediction score; this might be the key to allowing optimization and standardization of patient triage in the ED.…”

SARS-CoV-2 Infection in Venezuelan Pediatric Patients: A Single Center Prospective Observational Study

“…The prevalence of moderate or severe COVID-19 was higher in children under two years old, suggesting the need to evaluate and provide exhaustive follow-up for SARS-CoV-2 infections in infants. The levels of IL-6 can be an excellent prognostic factor; however, C-reactive protein, the acute phase reactant induced by IL-6, may provide helpful guidelines at a lower cost [26][27]. Among the main differential findings of cytokine levels and cellularity in relation to the age group, the highest levels of IL-10 and leukocyte count in infants stand out regarding preschoolers, schoolchildren and adolescents, which is considered part of the expected physiological behavior due to the maturity of the immune system, where the number of leukocytes is high at birth, with an increase in the first 12 weeks of life and then followed by a decrease and stability during the first 2 years of age, to then continue a progressive decrease in the ages of preschool, school and adolescence until reaching values similar to those of adults.…”

“…Breastfeeding in this age group may confer a protective role;breast milk contains a multitude of immunologically active components, including interleukin (IL)-10, a major regulatory cytokine of inflammatory responses, which, helps infants in the essential immune adaptations [28,29]. The high IL-10 levels may play a role in T reg response in the pediatric population [21,[26][27]. The levels of IFNγ only were correlated with age and contrasted those of IL-10, suggesting that at a younger age, the Th1 response is less prominent.…”

Long‐term risk of herpes zoster following COVID‐19: A retrospective cohort study of 2 442 686 patients

“…We suggest that the authors classify the severity of COVID-19 by incorporating diagnostic codes of other comorbid conditions or the types of medications administered to patients. 2,3 This approach may help elucidate the risk of subsequent herpes zoster in COVID-19 patients across various severity levels.…”

“…Wen-Bin Yeh 2 Hui-Yuan Chen 3 Su-Boon Yong 4 1 School of Medicine, Chung Shan Medical University, Taichung, Taiwan 2 Department of Emergency Medicine,…”