The Prognostic Value of Eosinophil Recovery in COVID-19: A Multicentre, Retrospective Cohort Study on Patients Hospitalised in Spanish Hospitals.

Mateos Gonzalez, M.; Sierra Gonzalo, E.; Casado Lopez, I.; Arnalich Fernandez, F.; Beato Perez, J. L.; Monge Monge, D.; Vargas Nunez, J. A.; Garcia Fenoll, R.; Suarez Fernandez, C.; Freire Castro, S. J.; Mendez Bailon, M.; Perales Fraile, I.; Madrazo, M.; Pesqueira Fontan, P. M.; Magallanes Gamboa, J. O.; Gonzalez Garcia, A.; Crestelo Vieitez, A.; Fonseca Aizpuru, E. M.; Aranguren Arostegui, A.; Coduras Erdozain, A.; Martinez Cilleros, C.; Loureiro Amigo, J.; Epelde, F.; Lumbreras Bermejo, C.; Anton Santos, J. M.

Objectives: A decrease in blood cell counts, especially lymphocytes and eosinophils, has been described in patients with severe SARS-CoV-2 (COVID-19), but there is no knowledge of the potential role of their recovery in these patients prognosis. This article aims to analyse the effect of blood cell depletion and blood cell recovery on mortality due to COVID-19. Design: This work is a multicentre, retrospective, cohort study of 9,644 hospitalised patients with confirmed COVID-19 from the Spanish Society of Internal Medicine SEMI-COVID-19 Registry. Setting: This study examined patients hospitalised in 147 hospitals throughout Spain. Participants: This work analysed 9,644 patients (57.12% male) out of a cohort of 12,826 patients over 18 years of age hospitalised with COVID-19 in Spain included in the SEMI-COVID-19 Registry as of 29 May 2020. Main outcome measures: The main outcome measure of this work is the effect of blood cell depletion and blood cell recovery on mortality due to COVID-19. Univariate analysis was performed to determine possible predictors of death and then multivariate analysis was carried out to control for potential confounders. Results: An increase in the eosinophil count on the seventh day of hospitalisation was associated with a better prognosis, including lower mortality rates (5.2% vs 22.6% in non-recoverers, OR 0.234 [95% CI, 0.154 to 0.354]) and lower complication rates, especially regarding to development of acute respiratory distress syndrome (8% vs 20.1%, p=0.000) and ICU admission (5.4% vs 10.8%, p=0.000). Lymphocyte recovery was found to have no effect on prognosis. Treatment with inhaled or systemic glucocorticoids was not found to be a confounding factor. Conclusion: Eosinophil recovery in patients with COVID-19 is a reliable marker of a good prognosis that is independent of prior treatment. This finding could be used to guide discharge decisions.