Subject(s)
COVID-19/blood , Megakaryocytes/physiology , Purpura, Thrombocytopenic, Idiopathic/blood , SARS-CoV-2 , Thrombophilia/etiology , COVID-19/complications , Cytokines/physiology , Humans , Lung/pathology , Microcirculation , Models, Biological , Purpura, Thrombocytopenic, Idiopathic/complications , Purpura, Thrombocytopenic, Idiopathic/epidemiology , Receptors, Thrombopoietin/agonists , Risk Factors , Thrombophilia/blood , Thrombophilia/epidemiology , Thrombopoiesis , Thrombopoietin/metabolism , Thrombotic Microangiopathies/blood , Thrombotic Microangiopathies/etiology , Thrombotic Microangiopathies/physiopathology , von Willebrand Factor/metabolismABSTRACT
Temporal resolution of cellular features associated with a severe COVID-19 disease trajectory is needed for understanding skewed immune responses and defining predictors of outcome. Here, we performed a longitudinal multi-omics study using a two-center cohort of 14 patients. We analyzed the bulk transcriptome, bulk DNA methylome, and single-cell transcriptome (>358,000 cells, including BCR profiles) of peripheral blood samples harvested from up to 5 time points. Validation was performed in two independent cohorts of COVID-19 patients. Severe COVID-19 was characterized by an increase of proliferating, metabolically hyperactive plasmablasts. Coinciding with critical illness, we also identified an expansion of interferon-activated circulating megakaryocytes and increased erythropoiesis with features of hypoxic signaling. Megakaryocyte- and erythroid-cell-derived co-expression modules were predictive of fatal disease outcome. The study demonstrates broad cellular effects of SARS-CoV-2 infection beyond adaptive immune cells and provides an entry point toward developing biomarkers and targeted treatments of patients with COVID-19.