Persistent lymphopenia after diagnosis of COVID-19 predicts acute respiratory distress syndrome: A retrospective cohort study

[摘要] Background: Lymphopenia is a marker of immunosuppression after severe coronavirus disease-2019 (COVID-19) whichis characterized by acute respiratory distress syndrome (ARDS). This study aimed to evaluate the relationships betweenpersistent lymphopenia and ARDS.Methods: A retrospective cohort study of 125 patients with COVID-19 admitted to government-designated treatmentcenter between 14 January 2020, and 20 March 2020 was conducted. We recorded all complete blood cell counts duringthe day 0th, 3rd, and 7th following the diagnosis of COVID-19. Patients were grouped based on the depression of thelymphocyte cell count, their return, or their failure to normal. The primary outcome was the occurrence of ARDS, andsecondary outcomes included developing vital organ dysfunction and hospital lengths of stay.Results: 17.6% (22/125) patients developed ARDS. The lymphocyte counts with ARDS and non-ARDS were 0.94 × 109/L,1.20 × 109/L at admission, respectively (p = 0.02). On the 3rd and 7th day, the median of lymphocyte count in ARDS wassignificantly lower than that of non-ARDS. Multivariable logistic regression, which was adjusting for potentially confoundingfactors (including age, comorbidities, and APACHE II score), showed that persistent lymphopenia within the 7th day wasindependently associated with ARDS (OR, 3.94 [95% CI, 1.26–12.33, p = 0.018). Further, patients with persistentlymphopenia had longer hospital lengths of stay (p < 0.001).Conclusion: The results showed persistent lymphopenia predicted ARDS after COVID-19. Further studies are needed toinvestigate whether immunostimulation of lymphocytes within 1 week can reduce ARDS occurrence in patients with COVID-19.

[学科分类] 内科医学

[关键词] lymphopenia;acute respiratory distress syndrome;coronavirus disease-2019