Clinical characteristics and predictive value of lower CD4(+)T cell level in patients with moderate and severe COVID-19: a multicenter retrospective study

Wen, Xue-song; Jiang, Dan; Gao, Lei; Zhou, Jian-zhong; Xiao, Jun; Cheng, Xiao-cheng; He, Bin; Chen, Yue; Lei, Peng; Tan, Xiao-wei; Qin, Shu; Zhang, Dong-ying

BACKGROUND: In December 2019, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, Hubei, China. Moreover, it has become a global pandemic. This is of great value in describing the clinical symptoms of COVID-19 patients in detail and looking for markers which are significant to predict the prognosis of COVID-19 patients. METHODS: In this multicenter, retrospective study, 476 patients with COVID-19 were enrolled from a consecutive series. After screening, a total of 395 patients were included in this study. All-cause death was the primary endpoint. All patients were followed up from admission till discharge or death. RESULTS: The main symptoms observed in the study included fever on admission, cough, fatigue, and shortness of breath. The most common comorbidities were hypertension and diabetes mellitus. Patients with lower CD4(+)T cell level were older and more often male compared to those with higher CD4(+)T cell level. Reduced CD8(+)T cell level was an indicator of the severity of COVID-19. Both decreased CD4(+)T [HR:13.659; 95%CI: 3.235–57.671] and CD8(+)T [HR: 10.883; 95%CI: 3.277–36.145] cell levels were associated with in-hospital death in COVID-19 patients, but only the decrease of CD4(+)T cell level was an independent predictor of in-hospital death in COVID-19 patients. CONCLUSIONS: Reductions in lymphocytes and lymphocyte subsets were common in COVID-19 patients, especially in severe cases of COVID-19. It was the CD8(+)T cell level, not the CD4(+)T cell level, that reflected the severity of the patient’s disease. Only reduced CD4(+)T cell level was independently associated with increased in-hospital death in COVID-19 patients. TRIAL REGISTRATION: Prognostic Factors of Patients With COVID-19, NCT04292964. Registered 03 March 2020. Retrospectively registered. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-020-05741-w.