Clinical characteristics and predictive value of lower CD4+T cell level in patients with moderate and severe COVID-19: A multicenter retrospective study
Abstract Background In December 2019, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, Hubei, China. And, it has become a global pandemic. This is of great value for describing the patient's clinical symptoms in detail and looking for markers which are significant to predict the prognosis of patients with COVID-19.MethodsIn this multicenter, retrospective study, 476 patients with COVID-19 were recruited from a consecutive series. After screening, a total of 395 patients were included in this study. All-cause death was the primary endpoint. All patients were followed up from admission till discharge or death.ResultsThe dominant symptoms observed in the study included fever on admission, cough, fatigue, and shortness of breath. The most common comorbidities were hypertension and diabetes. Compared with patients with higher CD4+T cell level, patients with lower CD4+T cell level were older and mostly males. The reduction of CD8+T cell level is an indicator of the severity of COVID-19. Both decreased CD4+T [HR:13.659; 95%CI: 3.235-57.671] and CD8+T [HR: 10.883; 95%CI: 3.277-36.145] cell levels were associated with in-hospital death in COVID-19 patients, but only the decrease of CD4+T cell level was an independent predictor of in-hospital death in COVID-19 patients. ConclusionsReductions in lymphocytes and lymphocyte subsets were common in COVID-19 patients, especially in severe COVID-19 cases. It was the CD8+T cell level, not the CD4+T cell level, that reflected the severity of the patient’s disease. Only the reduction in CD4+T cell level was independently associated with increased in-hospital death in COVID-19 patients.