The immune inflammation factors associated with disease severity and poor prognosis in patients with COVID-19: A retrospective cohort study

Yanli Kang; Shifa Lu; Ruifang Zhong; Jianbin You; Jiahao Chen; Ling Li; Rongbin Huang; Yanyan Xie; Falin Chen; Jinhua Chen; Liangyuan Chen

doi:10.1016/j.heliyon.2023.e23583

The immune inflammation factors associated with disease severity and poor prognosis in patients with COVID-19: A retrospective cohort study

Heliyon. 2023 Dec 12;10(1):e23583. doi: 10.1016/j.heliyon.2023.e23583. eCollection 2024 Jan 15.

Authors

Affiliations

¹ Department of Clinical Laboratory, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.
² Department of Clinical Laboratory, JianOu Municipal Hospital of Fujian Province, Nanping, China.
³ Department of Clinical Laboratory, The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China.

Abstract

Coronavirus disease 2019 (COVID-19) is associated with immune dysregulation and cytokine storm. It is essential to explore the immune response characteristics of peripheral circulation in COVID-19 patients to reveal pathogenesis and predict disease progression. In this study, the levels of total immunoglobulins (IgG, IgM, IgA), complement (C3, C4)，lymphocyte subsets (CD3⁺ cell，CD4+ cell，CD8+ cell, NK cell, CD19⁺ cell and CD45⁺ cell) and cytokines (IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-17, IL-12p, IL-1β, TNF-α, IFN-α and IFN-γ) were retrospectively analyzed in COVID-19 patients. A total of 513 patients were enrolled in this study, cases were distributed according to clinical status as mild or moderate (n = 212), severe survivors (n = 197) and severe non-survivors (n = 104). IL-6, IL-8, IL-10 and IFN-γ were increased in severe patients compared with non-severe patients, despite decreased CD45⁺ cell, CD3⁺ cell, CD4⁺ cell, CD8⁺ cell, CD19⁺ cell, and NK cell. Compared with severe survivors, the levels of L-6, IL-8 and IL-10 in non-survivors increased significantly, and levels of C3, CD45⁺ cell, CD3⁺ cell，CD4+ cell，CD8+ cell, and NK cell decreased. Moreover, age, IL-8, IL-10, CD8+cells and NK cell were independent risk factors for the severity of COVID-19. Multivariable regression showed increasing odds ratio of in-hospital death associated with tumor, older age, higher IL-8 level, and decreasing odds ratio of in-hospital death associated with increased levels of CD8+cell and NK cell. Finally, patients with tumor, or high IL-6 or high IL-10 expression and lower CD8⁺ or lower NK levels exhibited a significantly shorter survival time. In conclusion, our study provides findings of the immunological characteristics associated with disease severity to predict the progression of COVID-19. The immune inflammation factors, such as IL-6, IL-8, IL-10, CD8⁺ cell and NK cell, could serve as excellent biomarkers for monitoring or predicting COVID-19 progression therapeutic to COVID-19 patients.

Keywords: CD8+; COVID-19; IL-10; IL-6; Immunological characteristics.