Diffuse Large B-Cell Lymphomas (DLBCL) with Hepatitis-C Virus (HCV) Infection: Incidence, Clinical Outcome and Preliminary Results of Antiviral Treatments (AVT) after Chemotherapy.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2442-2442
Author(s):  
Pellegrino Musto ◽  
Stefano Luminari ◽  
Amalia De Renzo ◽  
Marcello Persico ◽  
Emilio Iannitto ◽  
...  
Keyword(s):  
Viral Load ◽  
Liver Biopsy ◽  
Clinical Outcome ◽  
High Viral Load ◽  
Hcv Infection ◽  
Low Grade ◽  
Virus Clearance ◽  
Long Term Follow Up ◽  
Remission Phase ◽  
Work Up

Abstract A possible relationship between HCV and some sub-types of low-grade lymphomas (in particular, immunocytomas and nodal/extranodal marginal lymphomas) has been suggested. In these patients, AVT has shown to be effective in inducing neoplastic regression without chemotherapy (CT). In the present study we aimed to define epidemiological, clinical and therapeutic issues in DLBCL with concomitant HCV infection. We evaluated the incidence of HCV infection in 881 consecutive Italian patients with DLBCL (676 of whom collected by GISL - Gruppo Italiano Studio Linfomi, and 205 by ISS - Istituto Superiore di Sanità), in whom HCV determination was available. We found that 105 out of them (11.9%) were HCV+ve. We also looked at the clinical outcome of 61 patients, who had complete clinical and laboratory work-up and long term follow-up. With respect to a cohort of comparable historical controls without HCV infection, HCV+ve DLBCL showed older age (62 vs 48 years, p < 0.03), more frequently signs of liver damage (59% vs 8%, p < 0.001) and presence of monoclonal gammopathy (17% vs 3%, p < 0.05), increased rate of autoimmune disorders (19% vs 3 %, p < 0.02) and extranodal localizations (65.3% vs 35%, p < 0.04), including, in particular, liver, spleen, and other unusual sites (esophagous, vagina), often as primitive disease. First line CT for HCV+ve DLBCL. mainly consisted of classic/modified CHOP+/−rituximab or PROMACE-CytaBOM regimens. Response rate (complete + partial remission) was not different, approaching 60% in both groups. Six-year overall survival (OS) was also similar (62% for HCV+ve and 65% for HCV−ve DLBCL, p 0.67). However, during the first two years, there was a worse trend for HCV+ve patients with increased ALT levels, high viral load (> 800.000 IU RNA viral copies) and evidence of active hepatitis or cirrhosis at liver biopsy. Finally, we evaluated the possible role of AVT given after standard CT in HCV+ve DLBCL. Preliminary data available from 37 patients who have received at least three months of interferon (alpha or pegylated) +/− ribavirin in remission phase, indicate that such a sequential treatment is feasible, may induce complete virus clearance and may be associated with prolonged remission duration, without affecting, however, OS. In conclusion, about 12% of Italian patients with DBLCL have concomitant HCV infection and show some distinctive clinical and biological characteristics. In absence of liver dysfunction, these subjects should receive standard treatments as their HCV−ve counterparts. Monitoring of viral load and liver biopsy appears also to be useful for an appropriate management. A sequence of standard CT followed by AVT is a feasible approach which warrants to be further investigated.

Diffuse B-Large Cell Lymphomas (DBLCL) with Hepatitis-C Virus (HCV) Infection: Clinical Outcome and Preliminary Results of a Pilot Study Combining R-CHOP with Antiviral Therapy.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2447-2447 ◽  
Author(s):  
Pellegrino Musto ◽  
Matteo Dell’Olio ◽  
Antonio La Sala ◽  
Saverio Mantuano ◽  
Nicola Cascavilla
Keyword(s):  
Stem Cell ◽  
Viral Load ◽  
Liver Biopsy ◽  
Clinical Outcome ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Liver Dysfunction ◽  
Hcv Infection ◽  
Infection Prevalence ◽  
Hodgkin's Lymphomas

Abstract Epidemiological studies indicate that HCV infection prevalence is higher in patients with B-cell non-Hodgkin’s lymphomas (B-NHL) than in general population or in other hematologic malignancies, thus contributing to confirm a possible pathogenetic role for HCV in lymphomagenesis. Such differences are particularly striking in Italian and Japanese populations, where it has been calculated that 5–12% of all B-NHL could be due to HCV. The relationship between HCV and B-NHL is stronger for some sub-types of low-grade B-NHL (immunocytomas and nodal/extranodal marginal zone lymphomas) where, interestingly, anti-viral therapy may induce regression of lymphoma. However, an association with HCV infection has been observed also within more aggressive histotypes, in particular in DBLCL. We evaluated the clinical outcome of 44 patients with DBLCL and concomitant HCV infection, diagnosed at our Institution from 1992 to 2000. These patients represented 19% of all 231 patients with DBLCL we observed throughout the same period. With respect to HCV- DLBCL, HCV+ DBLCL showed some distinctive clinico-pathological features, such as older age (61 vs 44 years, p &lt; 0.03), signs of liver damage (56.8% vs 6.9%, p &lt; 0.01), presence of monoclonal gammopathy, often with no clinically relevant cryoglobulinemic and/or rheumatoid activity (15.9% vs 4.2%, p &lt; 0.05), increased rate of autoimmune disorders (18.1% vs 2.6%, p &lt; 0.02) and extranodal localizations (61.3% vs 32%, p &lt; 0.04), including, in particular, liver, spleen and some very unusual sites, such as esophagous and vagina. First line chemotherapy for HCV+ DBLCL consisted of CHOP/CHOP-like +/-rituximab or PROMACE-CytaBOM regimens. Intensive chemotherapy followed by autologous peripheral blood stem cell transplantation was also performed in two patients. Response rate was 61.3% (69.5% for HCV- DBLCL, p n.s.). Overall survival (OS) at five years was 50% (53.4% for HCV- DBLCL, p n.s.). However, the evidence of increased ALT levels at diagnosis resulted in a worse prognosis, with a five-years OS of only 34% (p &lt; 0.02). High viral load and evidence of active hepatitis or cirrhosis at liver biopsy also were associated with more frequent hepatic failure under treatment and reduced survival. The concomitant administration of R-CHOP chemotherapy plus anti-viral treatment with peg-interferon (0.5-1 mcg/kg s.c., once-a-week) and ribavirin (1000-1200 mg/d p.o.) to four patients with HCV+ DBLCL showed excessive hematological toxicity. After this initial negative experience, we treated HCV+ DBLCL with R-CHOP (6–8 cycles) followed by a three months period of maintenance therapy with peg-interferon plus ribavirin. Such a sequential treatment was effective, better tolerated and resulted in a high rate of complete virus clearance in the first 12 patients so far treated. Thus, we recommend standard treatments as in their HCV- counterparts (including autologous stem cell transplantation) for HCV+ DBLCL patients without liver dysfunction. Monitoring of viral load and liver biopsy appears also to be useful for an appropriate management of these patients. Dose adaptation of chemotherapy and less intensive treatments are required in patients with sign of liver dysfunction. A sequence of standard chemotherapy followed by a short period of antiviral treatment is a feasible approach, requiring, however, a larger number of patients and a longer follow-up to establish its exact role in HCV+ DBLCL patients.

MR Imaging in Intrinsic Tectal Tumours

1997 ◽  
Vol 10 (4) ◽  
pp. 459-464
Author(s):  
G. Sparacia ◽  
S. Pappalardo ◽  
L. Manfrè ◽  
C. Sarno ◽  
T. Angileri ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Late Onset ◽  
Aqueductal Stenosis ◽  
Low Grade ◽  
Multiplanar Imaging ◽  
Show Evidence ◽  
Long Term Follow Up ◽  
Progressive Growth ◽  
Work Up

This article presents some anatomic and neuroradiologic clues in the identification of intrinsic tectal tumours and the main related problems of differential diagnosis. The majority of intrinsic tectal lesions are low-grade gliomas that have been recognized as a potential cause of late-onset aqueductal stenosis. The superb sensitivity of magnetic resonance (MR) imaging and its multiplanar imaging capability allow an optimal diagnostic accuracy in the tectal region. For this reason, MR imaging should be included in the work-up of all patients with neurological findings of brain stem dysfunction and late-onset aqueductal stenosis. Tectal gliomas particularly merit an accurate MR long-term follow-up monitoring, since they may ultimately show evidence of progressive growth and require therapeutic intervention to maintain disease control.

scholarly journals Mechanistic Signatures of Human Papillomavirus Insertions in Anal Squamous Cell Carcinomas

Cancers ◽  
2019 ◽  
Vol 11 (12) ◽  
pp. 1846 ◽  
Author(s):  
Adeline Morel ◽  
Cindy Neuzillet ◽  
Maxime Wack ◽  
Sonia Lameiras ◽  
Sophie Vacher ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Viral Load ◽  
Cervical Carcinoma ◽  
Squamous Cell ◽  
Pik3ca Mutation ◽  
High Viral Load ◽  
Response To Treatment ◽  
Anal Squamous Cell Carcinoma ◽  
Hpv Dna ◽  
Long Term Follow Up

The role of human papillomavirus (HPV) in anal squamous cell carcinoma (ASCC) carcinogenesis has been clearly established, involving the expression of viral oncoproteins and optional viral DNA integration into the host genome. In this article, we describe the various mechanisms and sites of HPV DNA insertion and assess their prognostic and predictive value in a large series of patients with HPV-positive ASCC with long-term follow-up. We retrospectively analyzed 96 tumor samples from 93 HPV-positive ASCC patients using the Capture-HPV method followed by Next-Generation Sequencing, allowing determination of HPV genotype and identification of the mechanisms and sites of viral genome integration. We identified five different mechanistic signatures of HPV insertions. The distribution of HPV signatures differed from that previously described in HPV-positive cervical carcinoma (p < 0.001). In ASCC samples, the HPV genome more frequently remained in episomal form (45.2%). The most common signature of HPV insertion was MJ-SC (26.9%), i.e., HPV–chromosomal junctions scattered at different loci. Functionally, HPV integration signatures were not associated with survival or response to treatment, but were associated with viral load (p = 0.022) and PIK3CA mutation (p = 0.0069). High viral load was associated with longer survival in both univariate (p = 0.044) and multivariate (p = 0.011) analyses. Finally, HPV integration occurred on most human chromosomes, but intragenic integration into the NFIX gene was recurrently observed (n = 4/51 tumors). Overall, the distribution of mechanistic signatures of HPV insertions in ASCC was different from that observed in cervical carcinoma and was associated with viral load and PIK3CA mutation. We confirmed recurrent targeting of NFIX by HPV integration, suggesting a role for this gene in ASCC carcinogenesis.

scholarly journals Integrative and episomal forms of genotype 16 of human papillomavirus in patients with cervical intraepithelial neoplasia and cervical cancer

2016 ◽  
Vol 61 (6) ◽  
pp. 270-274 ◽  
Author(s):  
M. K. Ibragimova ◽  
M. M. Tsyganov ◽  
I. V. Karabut ◽  
O. N. Churuksaeva ◽  
O. N. Shpileva ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Viral Load ◽  
Cervical Intraepithelial Neoplasia ◽  
Intraepithelial Neoplasia ◽  
High Viral Load ◽  
Low Grade ◽  
Squamous Intraepithelial Lesion ◽  
Comprehensive Survey ◽  
Intraepithelial Lesion

The study involved 500 patients with LSIL (low grade squamous intraepithelial lesion), HSIL (high grade squamous intraepithelial lesion), stage I-IV cervical cancer, infected with human papillomavirus (HPV), as well as 235 women without pathological changes in cervical mucosa. The comprehensive survey included colposcopy, cytological and histological analysis, detection and genotyping of high-risk human papillomavirus. Viral load and physical status of HPV16 DNA was evaluated in cases of mono-infection (n = 148). The prevalence of virus-positive cases among the patients with LSIL/NSIL, cervical cancer patients and healthy women was 69.2%, 76.7% and 51.9%, respectively. An association between the severity of disease and high viral load was revealed. The frequency of integrated DNA was strongly increased in patients with a high viral load. The frequency of episomal forms was either reduced or not detecteable in patients with high viral load as compared to patients with low viral load. It is reasonable to suggest that a high HPV16 viral load may cause an increase in the frequency of integration of virus DNA into the cellular/host genome. This suggests that a high HPV16 viral load may be considered as a risk factor for prognosis of cervical intraepithelial neoplasia and cervical cancer.

scholarly journals Adherence to a Fish-Rich Dietary Pattern Is Associated with Chronic Hepatitis C Patients Showing Low Viral Load: Implications for Nutritional Management

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3337
Author(s):  
Claudia Ojeda-Granados ◽  
Arturo Panduro ◽  
Karina Gonzalez-Aldaco ◽  
Ingrid Rivera-Iñiguez ◽  
Liliana Campos-Medina ◽  
...  
Keyword(s):  
Viral Load ◽  
Hepatitis C ◽  
High Viral Load ◽  
Hcv Infection ◽  
Hcv Rna ◽  
Spontaneous Clearance ◽  
Nutritional Management ◽  
Chronic Hcv ◽  
Few Data

Hepatitis C virus (HCV) infection is influenced by genetic (e.g., APOE polymorphisms) and environmental factors between the virus and the host. HCV modulates the host’s lipid metabolism but dietary components influence lipids and in vitro HCV RNA replication. Few data exist on the role of dietary features or patterns (DPs) in HCV infection. Herein, we aimed to evaluate the nutritional profiles of chronic HCV (CHC) and spontaneous clearance (SC) Mexican patients in the context of APOE alleles and their correlation with HCV-related variables. The fibrosis-related APOEε3 allele prevailed in CHC and SC patients, who had four DPs (“meat and soft drinks”, DP1; “processed animal and fried foods”, DP2; “Mexican-healthy”, DP3; and “fish-rich”, DP4). In CHC subjects, polyunsaturated fatty acid intake (PUFA ≥ 4.9%) was negatively associated, and fiber intake (≥21.5 g/d) was positively associated with a high viral load (p < 0.036). High adherence to fish-rich DP4 was associated with a higher frequency of CHC individuals consuming PUFA ≥ 4.9% (p = 0.004) and low viral load (p = 0.036), but a lower frequency of CHC individuals consuming fiber ≥ 21.5 g/d (p = 0.038). In SC and CHC individuals, modifying unhealthy DPs and targeting HCV-interacting nutrients, respectively, could be part of a nutritional management strategy to prevent further liver damage.

scholarly journals Comparative analysis of various clinical specimens in detection of SARS-CoV-2 using rRT-PCR in new and follow up cases of COVID-19 infection: Quest for the best choice

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249408
Author(s):  
Kuldeep Sharma ◽  
Pragya Aggarwala ◽  
Deepa Gandhi ◽  
Anuniti Mathias ◽  
Priyanka Singh ◽  
...  
Keyword(s):  
Viral Load ◽  
High Viral Load ◽  
Nasopharyngeal Swab ◽  
Clinical Specimens ◽  
Virus Clearance ◽  
Oropharyngeal Swab ◽  
Polymerase Chain ◽  
Novel Coronavirus ◽  
And Control

Background An appropriate specimen is of paramount importance in Real Time reverse transcription-polymerase chain reaction (rRT-PCR) based diagnosis of novel coronavirus (nCoV) disease (COVID-19). Thus, it’s pertinent to evaluate various diversified clinical specimens’ diagnostic utility in both diagnosis and follow-up of COVID-19. Methods A total of 924 initial specimens from 130 COVID-19 symptomatic cases before initiation of treatment and 665 follow up specimens from 15 randomly selected cases comprising of equal number of nasopharyngeal swab (NPS), oropharyngeal swab (OPS), combined NPS and OPS (Combined swab), sputum, plasma, serum and urine were evaluated by rRT-PCR. Results Demographic analysis showed males (86) twice more affected by COVID-19 than females (44) (p = 0.00001). Combined swabs showed a positivity rate of 100% followed by NPS (91.5%), OPS (72.3%), sputum (63%), while nCoV was found undetected in urine, plasma and serum specimens. The lowest cycle threshold (Ct) values of targeted genes E, ORF1b and RdRP are 10.56, 10.14 and 12.26 respectively and their lowest average Ct values were found in combined swab which indicates high viral load in combined swab among all other specimen types. Analysis of 665 follow-up multi-varied specimens also showed combined swab as the last specimen among all specimen types to become negative, after an average 6.6 (range 4–10) days post-treatment, having lowest (15.48) and average (29.96) Ct values of ORF1b respectively indicating posterior nasopharyngeal tract as primary nCoV afflicted site with high viral load. Conclusion The combined swab may be recommended as a more appropriate specimen for both diagnosis and monitoring of COVID-19 treatment by rRT-PCR for assessing virus clearance to help physicians in taking evidence-based decision before discharging patients. Implementing combined swabs globally will definitely help in management and control of the pandemic, as it is the need of the hour.

scholarly journals Casirivimab and imdevimab as investigational monoclonal antibodies for COVID-19 patients – review of the literature

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Gabriela Reka ◽  
Angelika Pawlak ◽  
Piotr Machowiec ◽  
Marcela Maksymowicz ◽  
Halina Piecewicz-Szczesna
Keyword(s):  
Monoclonal Antibodies ◽  
Viral Load ◽  
Animal Studies ◽  
Serum Antibody ◽  
High Viral Load ◽  
Supplemental Oxygen ◽  
Low Grade ◽  
Treatment Resistant ◽  
Human Igg1 ◽  
Antibody Cocktail

Abstract Casirivimab and imdevimab (REGN-COV-2) are investigational monoclonal antibodies approved in November 2020 by the Food and Drug Administration for emergency use in mild and moderate COVID-19. These two noncompeting human IgG1 monoclonal antibodies can target the receptor-binding domain of the spike protein of SARSCoV-2, prevent its entry into human cells, and reduce viral load. The antibodies can be administered intravenously for mild-to-moderate COVID-19 patients who do not require hospitalization and supplemental oxygen. The purpose of the study is to review the latest available data on COVID-19 treatment using casirivimab and imdevimab. According to recent preclinical studies, the antibody cocktail presents optimal antiviral strength and has the potential to minimize the chances of the virus escaping. It was shown in animal studies that the cocktail reduces the pathological consequences caused by viruses, decreases the number of viruses in the respiratory system, and reduces lung titers and pneumonia symptoms. Casirivimab and imdevimab as a cocktail also prevents the rapid appearance of treatment-resistant mutants. In the clinical trial, REGN-COV-2 decreased viral load, particularly in patients with a non-initiated immune response (serum antibody-negative) and with high viral load at baseline. The adverse effects were comparable in the combined REGN-COV2 dose groups (2.4 g and 8.0 g), as well as in the placebo group. The cocktail caused few and mainly low-grade toxic effects. Casirivimab and imdevimab seem to be effective and safe antiviral therapy for nonhospitalized patients with COVID-19. Further observations and research are extremely necessary to assess the efficacy, security and indications in a wider group of patients.

scholarly journals Higher levels of hepatitis C virus RNA found in blood donors co-infected with HIV as compared to HCV mono-infected donors

2014 ◽  
Vol 8 (08) ◽  
pp. 1068-1071 ◽  
Author(s):  
Enagnon Kazali Alidjinou ◽  
Donatien Moukassa ◽  
Eben Ebatetou-Ataboho ◽  
Gael Honal Mahoungou ◽  
Jean-Paul Pambou ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Viral Load ◽  
Hepatitis C ◽  
Blood Donors ◽  
Hiv Infections ◽  
High Viral Load ◽  
Hcv Infection ◽  
Hcv Rna ◽  
Infected People ◽  
Sub Saharan

Introduction: Hepatitis C virus (HCV) infection and human immunodeficiency virus (HIV) infections are public health problems in sub-Saharan countries such as the Republic of Congo. HIV infection could impact the characteristics of HCV infection in co-infected people. We investigated HCV-HIV co-infection among blood donors in Congo. Methodology: Ninety-nine HIV-positive and/or HCV-seropositive blood donors were selected during screening and subsequently tested for aminotransferases and HCV RNA. Results: A total of 29 donors were found positive for HCV RNA (HCV-infected individuals), including 19/60 (31.66%) HIV donors (co-infected) and 10/39 (25.64%) non-HIV donors (mono-infected). Most of the co-infected donors (17/19) displayed a high viral load (> 5 log). The median HCV RNA level was at least 2 logs higher in co-infected people. The levels of alanine aminotransferase (ALT) were also slightly higher in co-infected donors than in HCV mono-infected donors. Conclusion: This study reports HCV-HIV co-infection among blood donors in Congo and shows that HCV viral load is higher in HIV donors.

scholarly journals Immune phenotyping based on neutrophil-to-lymphocyte ratio and IgG predicts disease severity and outcome for patients with COVID-19

2020 ◽  
Author(s):  
Bicheng Zhang ◽  
Xiaoyang Zhou ◽  
Chengliang Zhu ◽  
Fan Feng ◽  
Yanru Qiu ◽  
...  
Keyword(s):  
Immune Response ◽  
Viral Load ◽  
Clinical Outcome ◽  
Antibody Response ◽  
Proinflammatory Cytokines ◽  
Recovery Rate ◽  
High Viral Load ◽  
Cd4 T Cell ◽  
Immune Phenotyping ◽  
Cd4 T Cell Count

SummaryBackgroundA recently emerging respiratory disease named coronavirus disease 2019 (COVID-19) has quickly spread across the world. This disease is initiated by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and uncontrolled cytokine storm, but it remains unknown as to whether a robust antibody response is related to clinical deterioration and poor outcome in laboratory-confirmed COVID-19 patients.MethodsAnti-SARS-CoV-2 IgG and IgM antibodies were determined by chemiluminescence analysis (CLIA) in COVID-19 patients from a single center in Wuhan. Median IgG and IgM levels in acute and convalescent-phase sera (within 35 days) for all included patients were calculated and compared among severe and nonsevere patients. Immune response phenotyping based on late IgG levels and neutrophil-to-lymphocyte ratio (NLR) was characterized to stratify patients with different disease severities and outcome. Laboratory parameters in patients with different immune response phenotypes and disease severities were analyzed.FindingsA total of 222 patients were included in this study. IgG was first detected on day 4 of illness, and its peak levels occurred in the fourth week. Severe cases were more frequently found in patients with high IgG levels, compared to those who with low IgG levels (51.8% versus 32.3%; p=0.008). Severity rates for patients with NLRhiIgGhi, NLRhiIgGlo, NLRloIgGhi, and NLRloIgGlo phenotype was 72.3%, 48.5%, 33.3%, and 15.6%, respectively (p<0.0001). Furthermore, severe patients with NLRhiIgGhi, NLRhiIgGlo had higher proinflammatory cytokines levels including IL-2, IL-6 and IL-10, and decreased CD4+ T cell count compared to those with NLRloIgGlo phenotype (p<0.05). Recovery rate for severe patients with NLRhiIgGhi, NLRhiIgGlo, NLRloIgGhi, and NLRloIgGlo phenotype was 58.8% (20/34), 68.8% (11/16), 80.0% (4/5), and 100% (12/12), respectively (p=0.0592). Dead cases only occurred in NLRhiIgGhi and NLRhiIgGlo phenotypes.InterpretationCOVID-19 severity is associated with increased IgG response, and an immune response phenotyping based on late IgG response and NLR could act as a simple complementary tool to discriminate between severe and nonsevere COVID-19 patients, and further predict their clinical outcome.Research in contextEvidence before this studyFollowing SARS-CoV-2 infection, a high viral load and overexuberant host immune response involving innate and acquired immunity, simultaneously contributes to the pathogenesis of COVID-19 and organ injury. Through searching PubMed and the China National knowledge infrastructure databases up to March 12, 2020, no published article focusing on anti-SARS-CoV-2 IgG-mediated immune response was identified.Added value of this studyWe evaluated antibody response within 35 days after symptom onset in laboratory-confirmed case with COVID-19 as one component of an overall exaggerated immune activation in severe SARS-CoV-2 infection, and developed an immune phenotyping based on late IgG response and NLR that could help determine disease severity and clinical outcome of COVID-19 patients. Severe cases were more frequently found in patients with high IgG levels, compared to those who with low IgG levels (51.8% versus 32.3%). Severity rates for patients with NLRhiIgGhi, NLRhiIgGlo, NLRloIgGhi, and NLRloIgGlo phenotype was 72.3%, 48.5%, 33.3%, and 15.6%, respectively. Furthermore, severe patients with NLRhiIgGhi, NLRhiIgGlo had higher proinflammatory cytokines levels including IL-2, IL-6 and IL-10, and decreased CD4+ T cell count compared to those with NLRloIgGlo phenotype. Recovery rate for severe patients with NLRhiIgGhi, NLRhiIgGlo, NLRloIgGhi, and NLRloIgGlo phenotype was 58.8% (20/34), 68.8% (11/16), 80.0% (4/5), and 100% (12/12), respectively.Implications of all the available evidenceCOVID-19 severity is associated with a high viral load and overexuberant IgG response. We developed an immune response phenotyping based on NLR and IgG that could act as a simple complementary tool to discriminate between severe and nonsevere COVID-19 patients and would be helpful in guiding clinical decision.

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