We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Along with PaO<sub>2</sub>/FiO<sub>2</sub> ratio and lymphopenia, low HLA-DR monocytes are the only additional parameter that independently predicts the clinical course of undifferentiated SARS-CoV-2 patients in emergency departments.
- Authors
Lafon, Thomas; Chapuis, Nicolas; Guerin, Estelle; Daix, Thomas; Otranto, Marcela; Boumediene, Ahmed; Jeannet, Robin; Fontenay, Michaela; Hani, Karam Henri; Vignon, Philippe; Monneret, Guillaume; François, Bruno; Jean-Philippe, Jais; Feuillard, Jean
- Abstract
Because one-third of patients deteriorate after their admission to the emergency department, assessing the prognosis of COVID-19 patients is of great importance. However, to date, only lymphopenia and the partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio have been reported as partly predictive of COVID-19–related further deterioration, and their association has not been evaluated. We asked whether other key biomarkers of SARS-CoV-2 immunologic defects—increase in circulating immature granulocytes, loss of monocyte HLA-DR (mHLA-DR) expression, and monocyte differentiation blockade—could also predict further COVID-19 deterioration. A series of 284 consecutive COVID-19 patients, with the sole inclusion criterion of being an adult, were prospectively enrolled at emergency department admission (day 0) of 2 different hospitals: 1 for the exploratory cohort (180 patients) and 1 for the confirmatory cohort (104 patients). Deterioration was assessed over the next 7 days. Neither increased immature granulocyte levels nor monocyte differentiation blockade predicted patient worsening. Among more than 30 clinical, biological, and radiological parameters, the value of decreased P/F ratio and lymphopenia for prediction of further COVID-19 deterioration was strongly confirmed, and the loss of mHLA-DR was the only additional independent marker. Combined together in a simple OxyLymphoMono score, the 3 variables perfectly predicted patients who did not worsen and correctly predicted worsening in 59% of cases. By highlighting lymphocyte and monocyte defects as preceding COVID-19 deterioration, these results point on early immunosuppression in COVID-19 deterioration. Combining P/F ratio, lymphopenia, and loss of mHLA-DR together in a simple and robust score could offer a pragmatic method for COVID-19 patient stratification.
- Subjects
HLA-DR antigens; HOSPITAL emergency services; SARS-CoV-2; LYMPHOPENIA; MONOCYTES
- Publication
Journal of Leukocyte Biology, 2024, Vol 115, Issue 6, p1131
- ISSN
0741-5400
- Publication type
Article
- DOI
10.1093/jleuko/qiae022