ABSTRACT
Immune dysregulation in COVID-19 is the major causal factor associated with disease progression and mortality. Role of monocyte HLA-DR (mHLA-DR), neutrophil CD64 (nCD64) and Immune dysregulation index (IDI) were studied in COVID-19 patients for assessing severity and outcome. Results were compared with other laboratory parameters. Antibody bound per cell for mHLA-DR, nCD64 and IDI were measured in 100 COVID-19 patients by flow cytometry within 12 h of hospital admission. Thirty healthy controls (HC) were included. Clinical and laboratory parameters like C - reactive protein (CRP), Procalcitonin (PCT), Absolute Lymphocyte count (ALC), Absolute Neutrophil count (ANC) and Neutrophil to Lymphocyte ratio (NLR) were recorded. Patients were followed up until recovery with discharge or death. Parameters from 54 mild (MCOV-19), 46 severe (SCOV-19) and 30 HC were analysed. mHLA-DR revealed significant and graded down regulation in MCOV-19 and SCOV-19 as compared to HC whereas IDI was lowest in HC with increasing values in MCOV-19 and SCOV-19. For diagnostic discrimination of MCOV-19 and SCOV-19, IDI revealed highest AUC (0.99). All three immune parameters revealed significant difference between survivors (n = 78) and non-survivors (n = 22). mHLA-DR < 7010 and IDI > 12 had significant association with mortality. Four best performing parameters to identify patients with SCOV-19 at higher risk of mortality were IDI, NLR, ALC and PCT. mHLA-DR and IDI, in addition to NLR and ALC at admission and during hospital stay can be utilized for patient triaging, monitoring, early intervention, and mortality prediction. IDI reported for the first time in this study, appears most promising. Immune monitoring of 'in hospital' cases may provide optimized treatment options. Supplementary Information: The online version contains supplementary material available at 10.1007/s12291-022-01087-z.
ABSTRACT
Objectives: Although several peripheral blood abnormalities have been reported in COVID 19,Leukoerythroblastosis is an unusual finding. We report 33 COVID19 cases presenting with leukoerythroblastosis. We intend to describe its incidence in this novel viral infection and correlate it with the clinical outcome. Methods: It is a Prospective study done at a Level 3 COVID 19 hospital of LUCKNOW, INDIA. Hematologic test records of day 1 of admission of COVID 19 cases admitted from 20th August 2020 to 30th September 2020 were reviewed. Peripheral blood smear examination was performed on test results that were flagged for abnormalities. Leukoerythroblastosis was reported when the smears showed presence of granulocyte left shift and nucleated red blood cells. Follow up smears were examined on Day 7. The findings were correlated with the clinical outcome. Results: Out of 274 slides reviewed, 33 (12%) showed a leukoerythroblastic picture on day 1 of admission. Follow up smears on day 7 were available in 76% (25/33) cases. The follow up smears showed improvement in 13 cases, worsening in 9 cases and no changes in 3 cases. There were total 19 (58%) deaths. 12 patients (36%) recovered and 2 patients (6%) were shifted to other hospitals whose further follow up was not available. Conclusions: Leukoerythroblastosis is an unusual presentation of COVID 19. Although rare, this peripheral blood abnormality can provide insight into the underlying pathophysiologic processes. Furthermore, it seems to be an adverse prognostic factor, so examination of follow up smears may help clinicians and intensivists to make prompt management decisions.