ABSTRACT
Background. Robust biomarkers that predict disease outcomes amongst COVID19 patients are necessary for both patient triage and resource prioritisation. Numerous candidate biomarkers have been proposed for COVID19. However, at present, there is no consensus on the best diagnostic approach to predict outcomes in infected patients. Moreover, it is not clear whether such tools would apply to other potentially pandemic pathogens and therefore of use as stockpile for future pandemic preparedness. Methods. We conducted a multi cohort observational study to investigate the biology and the prognostic role of interferon alpha inducible protein 27 (IFI27) in COVID19 patients. Findings. We show that IFI27 is expressed in the respiratory tract of COVID19 patients and elevated IFI27 expression is associated with the presence of a high viral load. We further demonstrate that systemic host response, as measured by blood IFI27 expression, is associated with COVID19 severity. For clinical outcome prediction (e.g. respiratory failure), IFI27 expression displays a high positive (0.83) and negative (0.95) predictive value, outperforming all other known predictors of COVID19 severity. Furthermore, IFI27 is upregulated in the blood of infected patients in response to other respiratory viruses. For example, in the pandemic H1N1/09 swine influenza virus infection, IFI27 like genes were highly upregulated in the blood samples of severely infected patients. Interpretation. These data suggest that prognostic biomarkers targeting the family of IFI27 genes could potentially supplement conventional diagnostic tools in future virus pandemics, independent of whether such pandemics are caused by a coronavirus, an influenza virus or another as yet to be discovered respiratory virus.
Subject(s)
Infections , Hematologic Diseases , Tumor Virus Infections , COVID-19 , Respiratory InsufficiencyABSTRACT
Background: A rapid outbreak of novel coronavirus, COVID-19, made it a global pandemic. This study focused on the possible association between lymphopenia and Computed tomography (CT) scan features and COVID-19 patient mortality. Method: The clinical data of 596 COVID-19 patients were collected from February 2020 to September 2020. The patients’ serological survey and CT scan features were retrospectively explored. Results: The median age of the patients was 56.7±16.4 years old. Lung involvement was more than 50% in 214 COVID-19 patients (35.9%). The average blood lymphocyte percentage was 20.35 ±10.16. The levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and platelet-to-lymphocyte ratio (PLR) may not indicate the severity and prognosis of COVID-19. Patients with severe lung involvement and lymphopenia were found to be significantly associated with increased odds of death (odds ratio [OR], 9.24; 95% confidence interval [95 CI%], 4.32- 19.78). These results indicated that lymphopenia <20% along with pulmonary involvement >50% impose a multiplicative effect on the risk of mortality. The in-hospital mortality rate of this group was significantly higher than other COVID-19 hospitalized cases. Furthermore, they meaningfully experienced a prolonged stay in the hospital (P= 0.00). Conclusion: The Lymphocyte count less than 20% and chest CT scan findings with more than 50% involvement might be related to the patient’s mortality. It could act as laboratory and clinical indicators of disease severity and mortality.