Lymphopenia and lung complications in patients with coronavirus disease-2019 (COVID-19): A retrospective study based on clinical data

J Med Virol. 2021 Sep;93(9):5425-5431. doi: 10.1002/jmv.27060. Epub 2021 May 13.

Abstract

A rapid outbreak of novel coronavirus, coronavirus disease-2019 (COVID-19), has made it a global pandemic. This study focused on the possible association between lymphopenia and computed tomography (CT) scan features and COVID-19 patient mortality. The clinical data of 596 COVID-19 patients were collected from February 2020 to September 2020. The patients' serological survey and CT scan features were retrospectively explored. The median age of the patients was 56.7 ± 16.4 years old. Lung involvement was more than 50% in 214 COVID-19 patients (35.9%). The average blood lymphocyte percentage was 20.35 ± 10.16 (normal range, 20%-50%). Although the levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were high in more than 80% of COVID-19 patients; CRP, ESR, and platelet-to-lymphocyte ratio (PLR) may not indicate the in-hospital mortality of COVID-19. Patients with severe lung involvement and lymphopenia were found to be significantly associated with increased odds of death (odds ratio, 9.24; 95% confidence interval, 4.32-19.78). These results indicated that lymphopenia < 20% along with pulmonary involvement >50% impose a multiplicative effect on the risk of mortality. The in-hospital mortality rate of this group was significantly higher than other COVID-19 hospitalized cases. Furthermore, they meaningfully experienced a prolonged stay in the hospital (p = .00). Lymphocyte count less than 20% and chest CT scan findings with more than 50% involvement might be related to the patient's mortality. These could act as laboratory and clinical indicators of disease severity, mortality, and outcome.

Keywords: COVID-19; lung CT scan; lymphopenia; mortality.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Biomarkers / blood
  • Blood Platelets / pathology
  • Blood Platelets / virology
  • Blood Sedimentation
  • C-Reactive Protein
  • COVID-19 / complications*
  • COVID-19 / diagnostic imaging
  • COVID-19 / mortality
  • COVID-19 / virology
  • Female
  • Hospital Mortality
  • Humans
  • Iran
  • Lung / pathology*
  • Lung / virology
  • Lymphocytes / pathology
  • Lymphocytes / virology
  • Lymphopenia / complications*
  • Lymphopenia / diagnostic imaging
  • Lymphopenia / mortality
  • Lymphopenia / virology
  • Male
  • Middle Aged
  • Pneumonia / complications*
  • Pneumonia / diagnostic imaging
  • Pneumonia / mortality
  • Pneumonia / virology
  • Retrospective Studies
  • SARS-CoV-2 / pathogenicity*
  • Severity of Illness Index
  • Survival Analysis
  • Tomography, X-Ray Computed

Substances

  • Biomarkers
  • C-Reactive Protein