Infect Dis Poverty . Increased circulating level of interleukin-6 and CD8 + T cell exhaustion are associated with progression of COVID-19

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Infect Dis Poverty


. 2020 Nov 25;9(1):161.
doi: 10.1186/s40249-020-00780-6.
Increased circulating level of interleukin-6 and CD8 ⁺ T cell exhaustion are associated with progression of COVID-19


Peng-Hui Yang ¹ , Yi-Bo Ding ² , Zhe Xu ³ , Rui Pu ² , Ping Li ² , Jin Yan ¹ , Ji-Luo Liu ² , Fan-Ping Meng ³ , Lei Huang ³ , Lei Shi ³ , Tian-Jun Jiang ³ , En-Qiang Qin ³ , Min Zhao ³ , Da-Wei Zhang ³ , Peng Zhao ³ , Ling-Xiang Yu ¹ , Zhao-Hai Wang ¹ , Zhi-Xian Hong ¹ , Zhao-Hui Xiao ¹ , Qing Xi ¹ , De-Xi Zhao ¹ , Peng Yu ¹ , Cai-Zhong Zhu ³ , Zhu Chen ³ , Shao-Geng Zhang ⁴ , Jun-Sheng Ji ⁵ , Fu-Sheng Wang ⁶ , Guang-Wen Cao ⁷



Affiliations

• PMID: 33239109
• DOI: 10.1186/s40249-020-00780-6

Abstract

Background: Coronavirus disease 2019 (COVID-19) is pandemic. It is critical to identify COVID-19 patients who are most likely to develop a severe disease. This study was designed to determine the clinical and epidemiological features of COVID-19 patients associated with the development of pneumonia and factors associated with disease progression.
Methods: Seventy consecutive patients with etiologically confirmed COVID-19 admitted to PLA General Hospital in Beijing, China from December 27, 2019 to March 12, 2020 were enrolled in this study and followed-up to March 16, 2020. Differences in clinical and laboratory findings between COVID-19 patients with pneumonia and those without were determined by the χ² test or the Fisher exact test (categorical variables) and independent group t test or Mann-Whitney U test (continuous variables). The Cox proportional hazard model and Generalized Estimating Equations were applied to evaluate factors that predicted the progression of COVID-19.
Results: The mean incubation was 8.67 (95% confidence interval, 6.78-10.56) days. Mean duration from the first test severe acute respiratory syndrome coronavirus 2-positive to conversion was 11.38 (9.86-12.90) days. Compared to pneumonia-free patients, pneumonia patients were 16.5 years older and had higher frequencies of having hypertension, fever, and cough and higher circulating levels of neutrophil proportion, interleukin-6, low count (< 190/?l) of CD8⁺ T cells, and neutrophil/lymphocyte ratio. Thirteen patients deteriorated during hospitalization. Cox regression analysis indicated that older age and higher serum levels of interleukin-6, C-reactive protein, procalcitonin, and lactate at admission significantly predicted the progression of COVID-19. During hospitalization, circulating counts of T lymphocytes, CD4⁺ T cells, and CD8⁺ T cells were lower, whereas neutrophil proportion, neutrophil/lymphocyte ratio, and the circulating levels of interleukin-6, C-reactive protein, and procalcitonin were higher, in pneumonia patients than in pneumonia-free patients. CD8⁺ lymphocyte count in pneumonia patients did not recover when discharged.
Conclusions: Older age and higher levels of C-reactive protein, procalcitionin, interleukin-6, and lactate might predict COVID-19 progression. T lymphocyte, especially CD8⁺ cell-mediated immunity is critical in recovery of COVID-19. This study may help in predicting disease progression and designing immunotherapy for COVID-19.

Keywords: CD8+ T cell exhaustion; COVID-19; Interleukin-6; Progression; Prospective case series.