Clinical and immunological features of severe and moderate coronavirus disease 2019 - PubMed (original) (raw)

Observational Study

. 2020 May 1;130(5):2620-2629.

doi: 10.1172/JCI137244.

Di Wu 1, Wei Guo 1, Yong Cao 2, Da Huang 1, Hongwu Wang 1, Tao Wang 2, Xiaoyun Zhang 1, Huilong Chen 1, Haijing Yu 1, Xiaoping Zhang 1, Minxia Zhang 3, Shiji Wu 3, Jianxin Song 1, Tao Chen 1, Meifang Han 1, Shusheng Li 4, Xiaoping Luo 5, Jianping Zhao 2, Qin Ning 1

Affiliations

Observational Study

Clinical and immunological features of severe and moderate coronavirus disease 2019

Guang Chen et al. J Clin Invest. 2020.

Abstract

BACKGROUNDSince December 2019, an outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, and is now becoming a global threat. We aimed to delineate and compare the immunological features of severe and moderate COVID-19.METHODSIn this retrospective study, the clinical and immunological characteristics of 21 patients (17 male and 4 female) with COVID-19 were analyzed. These patients were classified as severe (11 cases) and moderate (10 cases) according to the guidelines released by the National Health Commission of China.RESULTSThe median age of severe and moderate cases was 61.0 and 52.0 years, respectively. Common clinical manifestations included fever, cough, and fatigue. Compared with moderate cases, severe cases more frequently had dyspnea, lymphopenia, and hypoalbuminemia, with higher levels of alanine aminotransferase, lactate dehydrogenase, C-reactive protein, ferritin, and D-dimer as well as markedly higher levels of IL-2R, IL-6, IL-10, and TNF-α. Absolute numbers of T lymphocytes, CD4+ T cells, and CD8+ T cells decreased in nearly all the patients, and were markedly lower in severe cases (294.0, 177.5, and 89.0 × 106/L, respectively) than moderate cases (640.5, 381.5, and 254.0 × 106/L, respectively). The expression of IFN-γ by CD4+ T cells tended to be lower in severe cases (14.1%) than in moderate cases (22.8%).CONCLUSIONThe SARS-CoV-2 infection may affect primarily T lymphocytes, particularly CD4+ and CD8+ T cells, resulting in a decrease in numbers as well as IFN-γ production by CD4+ T cells. These potential immunological markers may be of importance because of their correlation with disease severity in COVID-19.TRIAL REGISTRATIONThis is a retrospective observational study without a trial registration number.FUNDINGThis work is funded by grants from Tongji Hospital for the Pilot Scheme Project, and partly supported by the Chinese National Thirteenth Five Years Project in Science and Technology for Infectious Disease (2017ZX10202201).

Keywords: COVID-19; Cytokines; Immunology; Infectious disease; Respiration; T cells.

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Conflict of interest statement

Conflict of interest: The authors have declared that no conflict of interest exists.

Figures

Figure 1

Figure 1. Computed tomography of the chest of patients with COVID-19.

Chest CT axial view lung window from a 62-year-old female with severe COVID-19 showing bilateral ground-glass opacity and subsegmental areas of consolidation on day 6 after symptom onset (A), and typical presentation of a white lung appearance with bilateral multiple lobular and subsegmental areas of consolidation on day 8 after symptom onset (B). Chest CT axial view lung window from a 32-year-old male with moderate COVID-19 showing bilateral ground-glass opacity on day 7 after symptom onset (C), and resolved bilateral ground-glass opacity on day 11 after symptom onset (D).

Figure 2

Figure 2. Plasma cytokine levels in patients with COVID-19.

Series of comparisons of plasma cytokine levels between severe cases (n = 9) and moderate cases (n = 7). All data presented as the mean ± SEM. Differences were tested using unpaired 2-sided Student’s t test.

Figure 3

Figure 3. Number of immune cell subsets and proportion of IFN-γ expression in patients with COVID-19.

(A) Flow cytometric analysis of NK cells, CD4+ T cells, CD8+ T cells, and Tregs as well as production of IFN-γ by CD4+ T cells, CD8+ T cells, and NK cells from a representative patient. (B) A series of comparisons of absolute number of total T and B lymphocytes, CD4+ T cells, CD8+ T cells, and NK cells between severe cases (n = 8) and moderate cases (n = 6). (C) A series of comparisons of production of IFN-γ by CD4+T cells, CD8+ T cells, and NK cells between severe cases (n = 6) and moderate cases (n = 7). All data presented as the mean ± SEM. Differences were tested using unpaired 2-sided Student’s t test.

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