6ca2384210b5b80a7e4b63cfbaf28852 244116.pdf 139dd6b02ef7deb589e32fb3083f7f4e0888b8b5 244116.pdf 4f03a8984750095eebb3d020818a548766cc16b425638314eddefb7587dfd5c6 244116.pdf Title: CD4 and CD8 Lymphocyte Counts as Surrogate Early Markers for Progression in SARS-CoV-2 Pneumonia: A Prospective Study Subject: Background: COVID-19 pathophysiology and the predictive factors involved are not fully understood, but lymphocytes dysregulation appears to play a role. This paper aims to evaluate lymphocyte subsets in the pathophysiology of COVID-19 and as predictive factors for severe disease. Patient and methods: A prospective cohort study of patients with SARS-CoV-2 bilateral pneumonia recruited at hospital admission. Demographics, medical history, and data regarding SARS-CoV-2 infection were recorded. Patients systematically underwent complete laboratory tests, including parameters related to COVID-19 as well as lymphocyte subsets study at the time of admission. Severe disease criteria were established at admission, and patients were classified on remote follow-up according to disease evolution. Linear regression models were used to assess associations with disease evolution, and Receiver Operating Characteristic (ROC) and the corresponding Area Under the Curve (AUC) were used to evaluate predictive values. Results: Patients with critical COVID-19 showed a decrease in CD3+CD4+ T cells count compared to non-critical (278 (485 IQR) vs. 545 (322 IQR)), a decrease in median CD4+/CD8+ ratio (1.7, (1.7 IQR) vs. 3.1 (2.4 IQR)), and a decrease in median CD4+MFI (21,820 (4491 IQR) vs. 26,259 (3256 IQR)), which persisted after adjustment. CD3+CD8+ T cells count had a high correlation with time to hospital discharge (PC = -0.700 (-0.931, -0.066)). ROC curves for predictive value showed lymphocyte subsets achieving the best performances, specifically CD3+CD4+ T cells (AUC = 0.756), CD4+/CD8+ ratio (AUC = 0.767), and CD4+MFI (AUC = 0.848). Conclusions: A predictive value and treatment considerations for lymphocyte subsets are suggested, especially for CD3CD4+ T cells. Lymphocyte subsets determination at hospital admission is recommended. Keywords: COVID-19; lymphocyte subsets; CD4+ T cells; predictive value; severity Author: Joan Calvet, Jordi Gratacós, María José Amengual, Maria Llop, Marta Navarro, Amàlia Moreno, Antoni Berenguer-Llergo, Alejandra Serrano, Cristóbal Orellana and Manel Cervantes Creator: LaTeX with hyperref package Producer: pdfTeX-1.40.18 CreationDate: Mon Nov 9 09:06:27 2020 CET ModDate: Mon Nov 9 09:06:27 2020 CET Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 13 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1123242 bytes Optimized: no PDF version: 1.5 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- DUKXPR+URWPalladioL-Ital Type 1 Custom yes yes no 56 0 UZSRXP+URWPalladioL-Bold Type 1 Custom yes yes no 57 0 ZSBPMM+VnURWPalladioL-Bold Type 1 Custom yes yes no 58 0 MTXWBE+URWPalladioL-Roma Type 1 Custom yes yes no 59 0 AZBFJT+VnURWPalladioL Type 1 Custom yes 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