J Autoimmun


. 2020 Apr 24;102473.
doi: 10.1016/j.jaut.2020.102473. Online ahead of print.
Characteristics and Prognostic Factors of Disease Severity in Patients With COVID-19: The Beijing Experience


Ying Sun 1 , Yanli Dong 2 , Lifeng Wang 3 , Huan Xie 4 , Baosen Li 5 , Christopher Chang 6 , Fu-Sheng Wang 7



Affiliations

Abstract

COVID-19 has become one of the worst infectious disease outbreaks of recent times, with over 2.1 million cases and 120,000 deaths so far. Our study investigated the demographic, clinical, laboratory and imaging features of 63 patients with COVID-19 in Beijing. Patients were classified into four groups, mild, moderate, severe and critically ill. The mean age of our patients was 47 years of age (range 3-85) and there was a slight male predominance (58.7%). Thirty percent of our patients had severe or critically ill disease, but only 20% of severe and 33% of critically ill patients had been to Wuhan. Fever was the most common presentation (84.1%), but cough was present in only slightly over half of the patients. We found that lymphocyte and eosinophils count were significantly decreased in patients with severe disease (p = 0.001 and p = 0.000, respectively). Eosinopenia was a feature of higher levels of severity. Peripheral CD4+, CD8+ T lymphocytes, and B lymphocytes were significantly decreased in severe and critically ill patients, but there was only a non-statistically significant downward trend in NK cell numbers with severity. Of note is that liver function tests including AST, ALT, GGT and LDH were elevated, and albumin was decreased. The inflammatory markers CRP, ESR and ferritin were elevated in patients with severe disease or worse. IL-6 levels were also higher, indicating that the presence of a hyperimmune inflammatory state portends higher morbidity and mortality. In a binary logistic regression model, C-reactive protein level (OR 1.073, [CI, 1.013-1.136]; p = 0.017), CD8 T lymphocyte counts (OR 0.989, [CI, 0.979-1.000]; p = 0.043), and D-dimer (OR 5.313, [CI, 0.325-86.816]; p = 0.241) were independent predictors of disease severity.

Keywords: 2019 novel coronavirus disease; COVID-19; Cytokine storm; Elevated liver enzymes; Interleukin-6; Lymphocyte subsets; Mortality; Prognosis; SARS-CoV-2.



Copyright 2020. Published by Elsevier Ltd.