ABSTRACT
Background Coronavirus disease 2019 (COVID-19), poses a threat to the global public health. Early identification of critical cases is crucial to providing timely treatment to patients. Here, we investigated whether white immune cell levels could predict respiratory decline, complications and mortality.Methods We performed a retrospective study including 119 patients presenting with COVID-19. We divided our cohort into two categories, using two different classifications. Comparison tests, prediction analysis and the logistic regression analysis were used in this study.Results The study revealed that a rise in neutrophils levels was associated with respiratory deterioration and intubation. In contrast, neutrophils levels plateaued in patients who remained stable. Neutrophils levels, during the first 5 days of hospitalization, positively correlated with the procalcitonin and C-reactive protein levels. Interestingly, neutrophils levels at day 5 proved to be a better predictor of intubation and acute respiratory distress syndrome than initial neutrophils counts, C-reactive protein or procalcitonin. Neutrophils counts at day 5 higher than 7,7 (109/l) (normal range: 1,4–7,7 (109/L) also effectively predicted patient mortality, independently of usual clinical classifications. Moreover, binary logistic regression with stratified revealed that neutrophils at day5 > 7,7 (109/l) was an independent risk factor of mortality and acute respiratory distress syndrome. Finally, neutrophils levels at day 5 and the proinflammatory cytokine IL-6 were correlated, which suggested a mechanistic link.Conclusions Our data showed that neutrophils count at day 5, rather than at admission, proved to be an excellent predictor of complications and mortality during hospitalization and could be used to improve COVID-19 patients’management.
Subject(s)
COVID-19ABSTRACT
SARS-CoV-2 infection fatality rate (IFR) doubles with every five years of age from childhood onward. Circulating autoantibodies neutralizing IFN-α, IFN-ω, and/or IFN-β are found in ~20% of deceased patients across age groups. In the general population, they are found in ~1% of individuals aged 20-70 years and in >4% of those >70 years old. With a sample of 1,261 deceased patients and 34,159 uninfected individuals, we estimated both IFR and relative risk of death (RRD) across age groups for individuals carrying autoantibodies neutralizing type I IFNs, relative to non-carriers. For autoantibodies neutralizing IFN-α2 or IFN-ω, the RRD was 17.0[95% CI:11.7-24.7] for individuals under 70 years old and 5.8[4.5-7.4] for individuals aged 70 and over, whereas, for autoantibodies neutralizing both molecules, the RRD was 188.3[44.8-774.4] and 7.2[5.0-10.3], respectively. IFRs increased with age, from 0.17%[0.12-0.31] for individuals <40 years old to 26.7%[20.3-35.2] for those ≥80 years old for autoantibodies neutralizing IFN-α2 or IFN-ω, and from 0.84%[0.31-8.28] to 40.5%[27.82-61.20] for the same two age groups, for autoantibodies neutralizing both molecules. Autoantibodies against type I IFNs increase IFRs, and are associated with high RRDs, particularly those neutralizing both IFN-α2 and -ω. Remarkably, IFR increases with age, whereas RRD decreases with age. Autoimmunity to type I IFNs appears to be second only to age among common predictors of COVID-19 death.
Subject(s)
COVID-19ABSTRACT
The COVID-19 global pandemic is now a public health emergency in Morocco. Reports on factors associated with prolonged viral shedding are not consistent. In this retrospective laboratory based study, time to RNA negative conversion is reported in a series of 129 patients monitored in a single laboratory in Casablanca. Risk factors associated with delayed negative conversion have been evaluated, by chi-squared test. Median delay of negative conversion was 22.5 days (IQR 17.75-29.0) from illness onset. Neither gender nor age were particularly associated with delayed viral clearance. Delayed time to hospital admission and disease severity were associated with prolonged viral shedding in this series. We recommend early diagnosis and treatment onset to reduce time to viral clearance and transmissibility of SARS-CoV-2 virus.