TY - JOUR
T1 - Immunological predictors of disease severity in patients with COVID-19
AU - Al Balushi, Asma
AU - AlShekaili, Jalila
AU - Al Kindi, Mahmood
AU - Ansari, Zainab
AU - Al-Khabori, Murtadha
AU - Khamis, Faryal
AU - Ambusaidi, Zaiyana
AU - Al Balushi, Afra
AU - Al Huraizi, Aisha
AU - Al Sulaimi, Sumaiya
AU - Al Fahdi, Fatma
AU - Al Balushi, Iman
AU - Pandak, Nenad
AU - Fletcher, Tom
AU - Nasr, Iman
N1 - Funding Information:
We thank the Ministry of Higher Education, Research and Innovation (MoHERI) for their great contribution in funding this research. We also thank the Tropical and Infectious Diseases Unit at the Royal Liverpool University Hospital for their support and help in facilitating this research and overall supervision of the primary author as part of a fellowship training program. We thank Dr Lamya Al Balushi from the Directorate General of Health Services, Ministry of Health, Oman for her help in facilitating the fieldwork.
Funding Information:
The study was supported by the Ministry of Higher Education, Research and Innovation (MoHERI) in Oman (TRC/CRP/MOH/COVID-19/20/26).
Funding Information:
Asma Al Balushi: Conceptualized and designed the study, wrote the research proposal, data collection for inpatients and field visits, communicated with patients, drafted and reviewed the manuscript, and overall workflow and integrity supervision. Jalila AlShekaili: Reviewed the study design, reviewed the research proposal, supervised receiving blood samples at the immunology laboratory, supervised the flow cytometry work and IL-6 assessment run and analysis, and interpreted the data, wrote up the first few drafts and approved the final draft of the manuscript. Mahmood Al Kindi: Reviewed the study design, reviewed the research proposal, supervised receiving blood samples at the immunology laboratory, supervised the flow cytometry work and IL-6 assessment run and analysis, analyzed the data, wrote up the first few drafts, and approved the final draft of the manuscript. Zainab Ansari: Field visits, data and sample collection from outpatients and inpatients, and data entry. Murtadha Al-Khabori: Data analysis, writing up results, and manuscript review. Faryal Khamis: Manuscript review and facilitating research work for inpatients. Zaiyana Ambusaidi: Data and sample collection from inpatients and data entry. Afra Al Balushi: Data and sample collection from inpatients and data entry. Aisha Al Huraizi: Data and sample collection from inpatients and data entry. Sumaiya Al Sulaimi: Data and sample collection from inpatients and data entry. Fatma Al Fahdi: Data and sample collection from inpatients and data entry. Iman Al Balushi: Data collection and entry for outpatients and second review of all data. Nenad Pandak: Manuscript review and facilitating research work for inpatients. Tom Fletcher: Overall supervision of the study and manuscript review. Iman Nasr: Proposal review, registered the study, communication with laboratories and companies, manuscript review, and overall workflow and integrity supervision. We thank the Ministry of Higher Education, Research and Innovation (MoHERI) for their great contribution in funding this research. We also thank the Tropical and Infectious Diseases Unit at the Royal Liverpool University Hospital for their support and help in facilitating this research and overall supervision of the primary author as part of a fellowship training program. We thank Dr Lamya Al Balushi from the Directorate General of Health Services, Ministry of Health, Oman for her help in facilitating the fieldwork. The study was supported by the Ministry of Higher Education, Research and Innovation (MoHERI) in Oman (TRC/CRP/MOH/COVID-19/20/26). Ethical approval was obtained through the Central Research Committee at the Ministry of Health in Oman (MoH/CSR/20/23605). Informed consent was obtained from all enrolled patients.
Publisher Copyright:
© 2021 The Authors
PY - 2021/9/1
Y1 - 2021/9/1
N2 - Background: Identifying the immune cells involved in coronavirus disease 2019 (COVID-19) disease progression and the predictors of poor outcomes is important to manage patients adequately. Methods: This prospective observational cohort study enrolled 48 patients with COVID-19 hospitalized in a tertiary hospital in Oman and 53 non-hospitalized patients with confirmed mild COVID-19. Results: Hospitalized patients were older (58 years vs 36 years, P < 0.001) and had more comorbid conditions such as diabetes (65% vs 21% P < 0.001). Hospitalized patients had significantly higher inflammatory markers (P < 0.001): C-reactive protein (114 vs 4 mg/l), interleukin 6 (IL-6) (33 vs 3.71 pg/ml), lactate dehydrogenase (417 vs 214 U/l), ferritin (760 vs 196 ng/ml), fibrinogen (6 vs 3 g/l), D-dimer (1.0 vs 0.3 μg/ml), disseminated intravascular coagulopathy score (2 vs 0), and neutrophil/lymphocyte ratio (4 vs 1.1) (P < 0.001). On multivariate regression analysis, statistically significant independent early predictors of intensive care unit admission or death were higher levels of IL-6 (odds ratio 1.03, P = 0.03), frequency of large inflammatory monocytes (CD14+CD16+) (odds ratio 1.117, P = 0.010), and frequency of circulating naïve CD4+ T cells (CD27+CD28+CD45RA+CCR7+) (odds ratio 0.476, P = 0.03). Conclusion: IL-6, the frequency of large inflammatory monocytes, and the frequency of circulating naïve CD4 T cells can be used as independent immunological predictors of poor outcomes in COVID-19 patients to prioritize critical care and resources.
AB - Background: Identifying the immune cells involved in coronavirus disease 2019 (COVID-19) disease progression and the predictors of poor outcomes is important to manage patients adequately. Methods: This prospective observational cohort study enrolled 48 patients with COVID-19 hospitalized in a tertiary hospital in Oman and 53 non-hospitalized patients with confirmed mild COVID-19. Results: Hospitalized patients were older (58 years vs 36 years, P < 0.001) and had more comorbid conditions such as diabetes (65% vs 21% P < 0.001). Hospitalized patients had significantly higher inflammatory markers (P < 0.001): C-reactive protein (114 vs 4 mg/l), interleukin 6 (IL-6) (33 vs 3.71 pg/ml), lactate dehydrogenase (417 vs 214 U/l), ferritin (760 vs 196 ng/ml), fibrinogen (6 vs 3 g/l), D-dimer (1.0 vs 0.3 μg/ml), disseminated intravascular coagulopathy score (2 vs 0), and neutrophil/lymphocyte ratio (4 vs 1.1) (P < 0.001). On multivariate regression analysis, statistically significant independent early predictors of intensive care unit admission or death were higher levels of IL-6 (odds ratio 1.03, P = 0.03), frequency of large inflammatory monocytes (CD14+CD16+) (odds ratio 1.117, P = 0.010), and frequency of circulating naïve CD4+ T cells (CD27+CD28+CD45RA+CCR7+) (odds ratio 0.476, P = 0.03). Conclusion: IL-6, the frequency of large inflammatory monocytes, and the frequency of circulating naïve CD4 T cells can be used as independent immunological predictors of poor outcomes in COVID-19 patients to prioritize critical care and resources.
KW - COVID-19
KW - Immunological predictors
KW - Inflammatory markers
KW - Lymphocyte subsets
KW - Mortality predictors
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U2 - 10.1016/j.ijid.2021.06.056
DO - 10.1016/j.ijid.2021.06.056
M3 - Article
C2 - 34216735
AN - SCOPUS:85111923321
SN - 1201-9712
VL - 110
SP - 83
EP - 92
JO - International Journal of Infectious Diseases
JF - International Journal of Infectious Diseases
ER -
