Clinical and immunological features of severe and moderate coronavirus disease 2019
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Abstract
Abstract Background Since late December, 2019, an outbreak of pneumonia cases caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, and continued to spread throughout China and across the globe. To date, few data on immunologic features of Coronavirus Disease 2019 (COVID-19) have been reported. Methods In this single-centre retrospective study, a total of 21 patients with pneumonia who were laboratory-confirmed to be infected with SARS-CoV-2 in Wuhan Tongji hospital were included from Dec 19, 2019 to Jan 27, 2020. The immunologic characteristics as well as their clinical, laboratory, radiological features were compared between 11 severe cases and 10 moderate cases. Results Of the 21 patients with COVID-19, only 4 (19%) had a history of exposure to the Huanan seafood market. 7 (33.3%) patients had underlying conditions. The average age of severe and moderate cases was 63.9 and 51.4 years, 10 (90.9%) severe cases and 7 (70.0%) moderate cases were male. Common clinical manifestations including fever (100%, 100%), cough (70%, 90%), fatigue (100%, 70%) and myalgia (50%, 30%) in severe cases and moderate cases. PaO2/FiO2 ratio was significantly lower in severe cases (122.9) than moderate cases (366.2). Lymphocyte counts were significantly lower in severe cases (0.7 × 10□/L) than moderate cases (1.1 × 10□/L). Alanine aminotransferase, lactate dehydrogenase levels, high-sensitivity C-reactive protein and ferritin were significantly higher in severe cases (41.4 U/L, 567.2 U/L, 135.2 mg/L and 1734.4 ug/L) than moderate cases (17.6 U/L, 234.4 U/L, 51.4 mg/L and 880.2 ug /L). IL-2R, TNF-α and IL-10 concentrations on admission were significantly higher in severe cases (1202.4 pg/mL, 10.9 pg/mL and 10.9 pg/mL) than moderate cases (441.7 pg/mL, 7.5 pg/mL and 6.6 pg/mL). Absolute number of total T lymphocytes, CD4 + T cells and CD8 + T cells decreased in nearly all the patients, and were significantly lower in severe cases (332.5, 185.6 and 124.3 × 10 6 /L) than moderate cases (676.5, 359.2 and 272.0 × 10 6 /L). The expressions of IFN-γ by CD4 + T cells tended to be lower in severe cases (14.6%) than moderate cases (23.6%). Conclusion The SARS-CoV-2 infection may affect primarily T lymphocytes, particularly CD4 + T cells, resulting in significant decrease in number as well as IFN-γ production, which may be associated with disease severity. Together with clinical characteristics, early immunologic indicators including diminished T lymphocytes and elevated cytokines may serve as potential markers for prognosis in COVID-19.
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Human recovery from SARS-CoV-2 infection seems to require both antibody and cell-mediated immune responses.
“Recovery following infection with SARS-CoV-2 in humans appears to involve both humoral and cell-mediated immunity22–24.”
From Immunological mechanisms of vaccine-induced protection against COVID-19 in humans (2021) · cites this paper as [24]
Th1 cells producing interferon-γ arise during acute infection, and a Th1-biased response has been proposed to associate with milder disease.
“Interferon-γ (IFNγ)-producing T helper 1 cells (TH1 cells) are produced during acute infection, and it has been suggested that this TH1 cell-biased phenotype is associated with less severe disease24,49”
From Immunological mechanisms of vaccine-induced protection against COVID-19 in humans (2021) · cites this paper as [24]
Patients infected with SARS-CoV-2 present elevated levels of IL-6, IL-10, IL-1β, INF-γ, CCL2, TNF-α, CXCL10, CCL7, IL-1 receptor antagonist and IL-2 receptor, supposedly associated with disease severity.
“Patients infected with SARS-CoV-2 present elevated levels of IL-6, IL-10, IL-1β, INF-γ, CCL2, TNF-α, CXCL10, CCL7, IL-1 receptor antagonist and IL-2 receptor, supposedly associated with disease severity [9, 98–105].”
From Hyperactivation of P2X7 receptors as a culprit of COVID-19 neuropathology (2021) · cites this paper as [101]
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- Authors
- Chen, G., Wu, D., Guo, W., Cao, Y., Huang, D., Wang, H., Wang, T., Zhang, X., Chen, H., Yu, H., Zhang, X., Zhang, M., Wu, S., Song, J., Chen, T., Han, M., Li, S., Luo, X., Zhao, J., & Ning, Q.
- Affiliations
- Tongji Hospital (CN)
- Corresponding author
- Ning, Qin
- ORCID
- Venue
- Journal of Clinical Investigation
- Published
- 2020-04-13
- Volume
- 130
- Issue
- 5
- Pages
- 2620-2629
- ISSN
- 0021-9738 (ISSN-L)
- 1558-8238
- PMC
- PMC7190990
- OpenAlex
- W3014003872
- Cited by
- 4,750
- References
- 6
- Citations by year
- 2026: 63 · 2025: 159 · 2024: 317 · 2023: 531 · 2022: 869 · 2021: 1402 · 2020: 1398 · 2019: 2 · 2018: 1 · 2017: 1 · 2015: 1 · 2013: 3 · 2012: 1
- FWCI
- 138.43
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Investigation (publishedVersion)
- medRxiv (acceptedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Tongji Hospital for Pilot Scheme Project (Tongji Hospital for Pilot Scheme Project)
- the Chinese National Thirteenth Five Years Project in Science and Technology (2017ZX10202201)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Keywords
- COVID-19 pandemic, SARS-CoV-2, disease severity, T cells, CD4+ T cells, CD8+ T cells, interferon-gamma, cytokines, lymphopenia, hypoalbuminemia, immunological markers, clinical features, D-dimer, ferritin, C-reactive protein, lactate dehydrogenase, alanine aminotransferase
- MeSH terms
- COVID-19, Adult, Aged, Cell Count, China, Female, Gene Expression Regulation, Humans, Male, Middle Aged, Pneumonia, Viral, Retrospective Studies, Severity of Illness Index, T-Lymphocytes, Cytokines, Coronavirus Infections, Gene Expression Profiling, Pandemics
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