Abstract:
Background:Identifying immune cells involved in COVID-19 disease progression and
predictors of poor outcomes is important to manage patients adequately.
Methods: A prospective observational cohort study enrolled 53
mild non-hospitalized and 48 hospitalized confirmed COVID-19 patients to
a tertiary hospital in Oman.
Results: Hospitalized patients were older (58 years vs 36
years, p <0.001) and had more comorbid conditions like
diabetes (65 % Vs 21% p <0.001). Hospitalized patients
had significantly higher inflammatory markers
(p <0.001); C-reactive protein (CRP) (114 vs 4 mg/L),
Interleukin-6 (IL-6) (33 vs 3.71pg/ml), lactate dehydrogenase (LDH) (417
vs 214 U/L), ferritin (760 vs 196 ng/mL), fibrinogen (6 vs 3 g/L),
D-dimer (1.0 vs 0.3 mcg/mL), disseminated intravascular coagulopathy
(DIC) score (2 vs 0) and neutrophil/lymphocyte ratio (4 vs 1.1),
(p <0.001). In multivariate regression analysis,
statistically significant independent early predictors of ICU admission
or death were higher levels of IL-6 (OR 1.03, p =0.03), frequency
of large inflammatory monocytes (CD14+CD16+) (OR 1.117, p =0.010)
and frequency of circulating naïve CD4+ T cells (CD27+CD28+CD45RA+CCR7+)
(OR 0.476, p =0.03).
Conclusion: IL-6, frequency of large inflammatory monocytes,
and circulating naïve CD4 T cells can be used as independent
immunological predictors of poor outcomes in COVID-19 patients to
prioritize critical care and resources.