Dynamic characteristics and predictive value of peripheral blood cells in patients with coronavirus disease 2019_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

QIN Zhijun ¹ , LIU Lei ² , SUN Qun ¹ , LIU Jiasheng ³ , LUO Jianfei ³ ,  LIU Dan ⁴

1. Department of Intensive Care Unit, Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan 610041, P. R. China;
2. Department of Infection Management, Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan 610041, P. R. China;
3. Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P. R. China;
4. Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

LIU Dan, Email: liudan10965@wchscu.cn

Keywords：

Coronavirus disease 2019; Neutrophil; Lymphocyte; Clinical outcome

DOI：

10.7507/1671-6205.202003137

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Objective To analyze dynamic characteristics of peripheral blood cells in patients with different types of coronavirus disease 2019 (COVID-19), so as to investigate the predictive value of peripheral blood cells and their dynamic changes for clinical outcome of patients with COVID-19.Methods Forty-eight patients with COVID-19 were collected and analyzed from East Hospital of Renmin Hospital of Wuhan University from February 2 to March 15, 2020. These patients were divided into general group (group A, 17 cases), severe survival group (group B, 21 cases), and severe death group (group C, 10 cases). Blood routine examination was done and analyzed before and after admission and among the three groups. The changes of neutrophils and lymphocytes were compared. The predictive power of neutrophils, lymphocytes, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) for clinical outcomes was analyzed through the receiver operating characteristic (ROC) curve.Results In group B, the lymphocyte count at discharge was significantly higher than at admission (P=0.002), and the neutrophil count, NLR and PLR were significantly lower than at admission (P values were 0.012, 0.001 and 0.007, respectively). The lymphocyte counts in the A, B, and C groups were ranked from high to low upon admission, and the differences among the three groups were statistically significant (P values were 0.020, <0.001 and 0.006 for the contrasts between groups A and B, groups A and C, groups B and C, respectively), the NLR were ranked from low to high, and the differences among the three groups were statistically significant (P values were 0.001, <0.001 and 0.026 for the contrasts between groups A and B, groups A and C, groups B and C, respectively). Before discharge or death, there was no significant difference in lymphocyte counts and NLR between A and B groups (P>0.05), and there were statistically significant differences between group C and groups A and B (all P values were<0.001). The proportions of “Neutrophils Lymphocytes Convergence” in groups A and B were 64.7% and 76.2%, respectively, which were significantly higher than that in group C (10.0%). The proportions of “Neutrophils Lymphocytes Separation” in group C was 70.0%, which was significantly higher than those in groups A (0) and B (4.8%). The area under the curve of NLR predicting patients with severe disease (excluding death) was 0.843, with the sensitivity and specificity of ≥3.55 be 0.810 and 0.882; The area under the curve of lymphocyte count predicting death in severe patients was 0.845, with the sensitivity and specificity be 0.700 and 0.905, respectively.Conclusions Dynamic changes in the composition of peripheral blood cells are one of the clinical features of COVID-19, “Neutrophils Lymphocytes Convergence” and “Neutrophils Lymphocytes Separation” predict better and worse clinical outcomes, respectively. NLR and lymphocyte counts are effective indicators for predicting the severity and death of COVID-19.

Citation： QIN Zhijun, LIU Lei, SUN Qun, LIU Jiasheng, LUO Jianfei, LIU Dan. Dynamic characteristics and predictive value of peripheral blood cells in patients with coronavirus disease 2019. Chinese Journal of Respiratory and Critical Care Medicine, 2020, 19(5): 457-462. doi: 10.7507/1671-6205.202003137 Copy

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9.	陳夕, 童瑾, 向建華, 等. 139 例新型冠狀病毒肺炎患者流行病學特點對重癥化影響的回顧性研究[J/OL]. 重慶醫學, [2020-03-13]. http://kns.cnki.net/kcms/detail/50.1097.R.20200313.1537.004.html.
10.	Kolber W, Ku?nierz-Cabala B, Maraj M, et al. Neutrophil to lymphocyte ratio at the early phase of acute pancreatitis correlates with serum urokinase-type plasminogen activator receptor and interleukin 6 and predicts organ failure. Folia Med Cracov, 2018, 58(4): 57-74.
11.	Chandrashekara S, Mukhtar Ahmad M, Renuka P, et al. Characterization of neutrophil-to-lymphocyte ratio as a measure of inflammation in rheumatoid arthritis. Int J Rheum Dis, 2017, 20(10): 1457-1467.
12.	Qin C, Zhou LQ, Hu ZW, et al. Dysregulation of immune response in patients with coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis, 2020, 71(15): 762-768.

1. 中華人民共和國國家衛生健康委員會. 新型冠狀病毒肺炎診療方案(試行第七版) [EB/OL]. [2020-03-04]. http://www.nhc.gov.cn/yzygj/s7653p/202003/46c9294a7dfe4cef80dc7f5912eb1989.shtml.
2. 向天新, 劉家明, 許飛, 等. 江西地區 49 例新型冠狀病毒肺炎患者臨床特征分析. 中國呼吸與危重監護雜志, 2020, 19(2): 154-160.
3. 李欣, 荊小莉, 關開泮, 等. SARS 中淋巴細胞變化與肺損傷嚴重程度的關系. 熱帶醫學雜志, 2005, 5(6): 795-795, 821.
4. 王蓉, 謝伶俐, 杜鵬, 等. 新型冠狀病毒肺炎 96 例臨床分析. 中國呼吸與危重監護雜志, 2020, 19(2): 144-147.
5. Zhang JJ, Dong X, Cao YY, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy, 2020, 75(7): 1730-1741.
6. 劉敏, 賀鵬, 劉輝國, 等. 30 例醫務人員新型冠狀病毒肺炎的臨床特征分析. 中華結核和呼吸雜志, 43(3): 209-214.
7. Yang WJ, Cao QQ, Qin L, et al. Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19): a multi-center study in Wenzhou city, Zhejiang, China. J Infect, 2020, 80(4): 388-393.
8. 陳蕾, 劉輝國, 劉威, 等. 2019 新型冠狀病毒肺炎 29 例臨床特征分析. 中華結核和呼吸雜志, 2020, 43(3): 203-208.
9. 陳夕, 童瑾, 向建華, 等. 139 例新型冠狀病毒肺炎患者流行病學特點對重癥化影響的回顧性研究[J/OL]. 重慶醫學, [2020-03-13]. http://kns.cnki.net/kcms/detail/50.1097.R.20200313.1537.004.html.
10. Kolber W, Ku?nierz-Cabala B, Maraj M, et al. Neutrophil to lymphocyte ratio at the early phase of acute pancreatitis correlates with serum urokinase-type plasminogen activator receptor and interleukin 6 and predicts organ failure. Folia Med Cracov, 2018, 58(4): 57-74.
11. Chandrashekara S, Mukhtar Ahmad M, Renuka P, et al. Characterization of neutrophil-to-lymphocyte ratio as a measure of inflammation in rheumatoid arthritis. Int J Rheum Dis, 2017, 20(10): 1457-1467.
12. Qin C, Zhou LQ, Hu ZW, et al. Dysregulation of immune response in patients with coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis, 2020, 71(15): 762-768.

Chinese Journal of Respiratory and Critical Care Medicine

Dynamic characteristics and predictive value of peripheral blood cells in patients with coronavirus disease 2019

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