Blood absolute lymphocyte count and trajectory are important in understanding severe COVID-19
Abstract Background Low blood absolute lymphocyte count (ALC) may predict severe COVID-19 outcomes. Knowledge gaps remain regarding the relationship of ALC trajectory with clinical outcomes and factors associated with lymphopenia. Methods Our post hoc analysis of the Therapeutics for Inpatients with...
Saved in:
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-01-01
|
| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-024-10428-7 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832594958395113472 |
|---|---|
| author | Catharine I. Paules Jacqueline A. Nordwall Kathryn Shaw-Saliba Judith A. Aberg Edward M. Gardner Anna L. Goodman N. Kumarasamy Shikha Vasudeva David M. Vock Crystal M. North Jens Lundgren Neil R. Aggarwal for the STRIVE Network and TICO Trial Study Group |
| author_facet | Catharine I. Paules Jacqueline A. Nordwall Kathryn Shaw-Saliba Judith A. Aberg Edward M. Gardner Anna L. Goodman N. Kumarasamy Shikha Vasudeva David M. Vock Crystal M. North Jens Lundgren Neil R. Aggarwal for the STRIVE Network and TICO Trial Study Group |
| author_sort | Catharine I. Paules |
| collection | DOAJ |
| description | Abstract Background Low blood absolute lymphocyte count (ALC) may predict severe COVID-19 outcomes. Knowledge gaps remain regarding the relationship of ALC trajectory with clinical outcomes and factors associated with lymphopenia. Methods Our post hoc analysis of the Therapeutics for Inpatients with COVID-19 platform trial utilized proportional hazards models to assess relationships between Day (D) 0 lymphopenia (ALC < 0.9 cells/uL), D0 severe lymphopenia (ALC < 0.5 cells/uL) or lymphopenia trajectory between D0 and D5 with mortality and secondary infections, and with sustained recovery using Fine-Gray models. Logistic regression was used to assess relationships between clinical variables and D0 lymphopenia or lymphopenia trajectory. Results D0 lymphopenia (1426/2579) and severe lymphopenia (636/2579) were associated with increased mortality (aHR 1.48; 1.08, 2.05, p = 0.016 and aHR 1.60; 1.20, 2.14, p = 0.001) and decreased recovery (aRRR 0.90; 0.82, 0.99, p = 0.033 and aRRR 0.78; 0.70, 0.87, p < 0.001 respectively). Trial participants with persistent D5 lymphopenia had increased mortality, and increased secondary infections, and participants with persistent or new lymphopenia had impaired recovery, as compared to participants with no lymphopenia. Persistent and new lymphopenia were associated with older age, male sex; prior immunosuppression, heart failure, aspirin use, and normal body mass index; biomarkers of organ damage (renal and lung), and ineffective immune response (elevated IL-6 and viral nucleocapsid antigen levels). Similar results were observed with severe lymphopenia. Conclusions Lymphopenia was predictive of severe COVID-19 outcomes, particularly when persistent or new during hospitalization. A better understanding of the underlying risk factors for lymphopenia will help illuminate disease pathogenesis and guide management strategies. |
| format | Article |
| id | doaj-art-27e6e78acaec49049a082250a6417edc |
| institution | Kabale University |
| issn | 1471-2334 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj-art-27e6e78acaec49049a082250a6417edc2025-01-19T12:11:44ZengBMCBMC Infectious Diseases1471-23342025-01-0125111510.1186/s12879-024-10428-7Blood absolute lymphocyte count and trajectory are important in understanding severe COVID-19Catharine I. Paules0Jacqueline A. Nordwall1Kathryn Shaw-Saliba2Judith A. Aberg3Edward M. Gardner4Anna L. Goodman5N. Kumarasamy6Shikha Vasudeva7David M. Vock8Crystal M. North9Jens Lundgren10Neil R. Aggarwal11for the STRIVE Network and TICO Trial Study GroupDivision of Infectious Diseases, Penn State Health Milton S. Hershey Medical CenterDivision of Biostatistics and Health Data Science, School of Public Health, University of MinnesotaDivision of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of HealthDepartment of Medicine, Icahn School of Medicine at Mount SinaiDenver Health and HospitalMRC Clinical Trials Unit at University College London and CIDR, King’s College London and Guy’s and St. Thomas’ NHS Foundation TrustVHS Infectious Diseases Medical Centre, CART Clinical Research Site, Voluntary Health ServicesDivision of Infectious Diseases, VA Medical CenterDivision of Biostatistics and Health Data Science, School of Public Health, University of MinnesotaDivision of Pulmonary and Critical Care Medicine, Massachusetts General HospitalCHIP Center of Excellence for Health, Immunity, and Infections, Department of Infectious Diseases, University of CopenhagenDivision of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of MedicineAbstract Background Low blood absolute lymphocyte count (ALC) may predict severe COVID-19 outcomes. Knowledge gaps remain regarding the relationship of ALC trajectory with clinical outcomes and factors associated with lymphopenia. Methods Our post hoc analysis of the Therapeutics for Inpatients with COVID-19 platform trial utilized proportional hazards models to assess relationships between Day (D) 0 lymphopenia (ALC < 0.9 cells/uL), D0 severe lymphopenia (ALC < 0.5 cells/uL) or lymphopenia trajectory between D0 and D5 with mortality and secondary infections, and with sustained recovery using Fine-Gray models. Logistic regression was used to assess relationships between clinical variables and D0 lymphopenia or lymphopenia trajectory. Results D0 lymphopenia (1426/2579) and severe lymphopenia (636/2579) were associated with increased mortality (aHR 1.48; 1.08, 2.05, p = 0.016 and aHR 1.60; 1.20, 2.14, p = 0.001) and decreased recovery (aRRR 0.90; 0.82, 0.99, p = 0.033 and aRRR 0.78; 0.70, 0.87, p < 0.001 respectively). Trial participants with persistent D5 lymphopenia had increased mortality, and increased secondary infections, and participants with persistent or new lymphopenia had impaired recovery, as compared to participants with no lymphopenia. Persistent and new lymphopenia were associated with older age, male sex; prior immunosuppression, heart failure, aspirin use, and normal body mass index; biomarkers of organ damage (renal and lung), and ineffective immune response (elevated IL-6 and viral nucleocapsid antigen levels). Similar results were observed with severe lymphopenia. Conclusions Lymphopenia was predictive of severe COVID-19 outcomes, particularly when persistent or new during hospitalization. A better understanding of the underlying risk factors for lymphopenia will help illuminate disease pathogenesis and guide management strategies.https://doi.org/10.1186/s12879-024-10428-7LymphocytesSARS-CoV-2Precision medicine |
| spellingShingle | Catharine I. Paules Jacqueline A. Nordwall Kathryn Shaw-Saliba Judith A. Aberg Edward M. Gardner Anna L. Goodman N. Kumarasamy Shikha Vasudeva David M. Vock Crystal M. North Jens Lundgren Neil R. Aggarwal for the STRIVE Network and TICO Trial Study Group Blood absolute lymphocyte count and trajectory are important in understanding severe COVID-19 BMC Infectious Diseases Lymphocytes SARS-CoV-2 Precision medicine |
| title | Blood absolute lymphocyte count and trajectory are important in understanding severe COVID-19 |
| title_full | Blood absolute lymphocyte count and trajectory are important in understanding severe COVID-19 |
| title_fullStr | Blood absolute lymphocyte count and trajectory are important in understanding severe COVID-19 |
| title_full_unstemmed | Blood absolute lymphocyte count and trajectory are important in understanding severe COVID-19 |
| title_short | Blood absolute lymphocyte count and trajectory are important in understanding severe COVID-19 |
| title_sort | blood absolute lymphocyte count and trajectory are important in understanding severe covid 19 |
| topic | Lymphocytes SARS-CoV-2 Precision medicine |
| url | https://doi.org/10.1186/s12879-024-10428-7 |
| work_keys_str_mv | AT catharineipaules bloodabsolutelymphocytecountandtrajectoryareimportantinunderstandingseverecovid19 AT jacquelineanordwall bloodabsolutelymphocytecountandtrajectoryareimportantinunderstandingseverecovid19 AT kathrynshawsaliba bloodabsolutelymphocytecountandtrajectoryareimportantinunderstandingseverecovid19 AT judithaaberg bloodabsolutelymphocytecountandtrajectoryareimportantinunderstandingseverecovid19 AT edwardmgardner bloodabsolutelymphocytecountandtrajectoryareimportantinunderstandingseverecovid19 AT annalgoodman bloodabsolutelymphocytecountandtrajectoryareimportantinunderstandingseverecovid19 AT nkumarasamy bloodabsolutelymphocytecountandtrajectoryareimportantinunderstandingseverecovid19 AT shikhavasudeva bloodabsolutelymphocytecountandtrajectoryareimportantinunderstandingseverecovid19 AT davidmvock bloodabsolutelymphocytecountandtrajectoryareimportantinunderstandingseverecovid19 AT crystalmnorth bloodabsolutelymphocytecountandtrajectoryareimportantinunderstandingseverecovid19 AT jenslundgren bloodabsolutelymphocytecountandtrajectoryareimportantinunderstandingseverecovid19 AT neilraggarwal bloodabsolutelymphocytecountandtrajectoryareimportantinunderstandingseverecovid19 AT forthestrivenetworkandticotrialstudygroup bloodabsolutelymphocytecountandtrajectoryareimportantinunderstandingseverecovid19 |