Similar Clinical Course and Significance of Circulating Innate and Adaptive Immune Cell Counts in STEMI and COVID-19

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Abstract

This study aimed to assess the time course of circulating neutrophil and lymphocyte counts and their ratio (NLR) in ST-segment elevation myocardial infarction (STEMI) and coronavirus disease (COVID)-19 and explore their associations with clinical events and structural damage. Circulating neutrophil, lymphocyte and NLR were sequentially measured in 659 patients admitted for STEMI and in 103 COVID-19 patients. The dynamics detected in STEMI (within a few hours) were replicated in COVID-19 (within a few days). In both entities patients with events and with severe structural damage displayed higher neutrophil and lower lymphocyte counts. In both scenarios, higher maximum neutrophil and lower minimum lymphocyte counts were associated with more events and more severe organ damage. NLR was higher in STEMI and COVID-19 patients with the worst clinical and structural outcomes. A canonical deregulation of the immune response occurs in STEMI and COVID-19 patients. Boosted circulating innate (neutrophilia) and depressed circulating adaptive immunity (lymphopenia) is associated with more events and severe organ damage. A greater understanding of these critical illnesses is pivotal to explore novel alternative therapies.

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Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report

Mark Peters (2021)

Abstract Background Coronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Glucocorticoids may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death. Methods In this controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized with Covid-19, we randomly assigned patients to receive oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days or to receive usual care alone. The primary outcome was 28-day mortality. Here, we report the preliminary results of this comparison. Results A total of 2104 patients were assigned to receive dexamethasone and 4321 to receive usual care. Overall, 482 patients (22.9%) in the dexamethasone group and 1110 patients (25.7%) in the usual care group died within 28 days after randomization (age-adjusted rate ratio, 0.83; 95% confidence interval [CI], 0.75 to 0.93; P<0.001). The proportional and absolute between-group differences in mortality varied considerably according to the level of respiratory support that the patients were receiving at the time of randomization. In the dexamethasone group, the incidence of death was lower than that in the usual care group among patients receiving invasive mechanical ventilation (29.3% vs. 41.4%; rate ratio, 0.64; 95% CI, 0.51 to 0.81) and among those receiving oxygen without invasive mechanical ventilation (23.3% vs. 26.2%; rate ratio, 0.82; 95% CI, 0.72 to 0.94) but not among those who were receiving no respiratory support at randomization (17.8% vs. 14.0%; rate ratio, 1.19; 95% CI, 0.91 to 1.55). Conclusions In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support. (Funded by the Medical Research Council and National Institute for Health Research and others; RECOVERY ClinicalTrials.gov number, NCT04381936; ISRCTN number, 50189673.)

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2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

Piotr Ponikowski, Adriaan A. Voors, Stefan D. Anker … (2016)

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Reduction and Functional Exhaustion of T Cells in Patients With Coronavirus Disease 2019 (COVID-19)

Bo Diao, Chenhui Wang, Yingjun Tan … (2020)

Background: The outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has posed great threat to human health. T cells play a critical role in antiviral immunity but their numbers and functional state in COVID-19 patients remain largely unclear. Methods: We retrospectively reviewed the counts of T cells and serum cytokine concentration from data of 522 patients with laboratory-confirmed COVID-19 and 40 healthy controls. In addition, the expression of T cell exhaustion markers were measured in 14 COVID-19 cases. Results: The number of total T cells, CD4+ and CD8+ T cells were dramatically reduced in COVID-19 patients, especially in patients requiring Intensive Care Unit (ICU) care. Counts of total T cells, CD8+ T cells or CD4+ T cells lower than 800, 300, or 400/μL, respectively, were negatively correlated with patient survival. T cell numbers were negatively correlated to serum IL-6, IL-10, and TNF-α concentration, with patients in the disease resolution period showing reduced IL-6, IL-10, and TNF-α concentrations and restored T cell counts. T cells from COVID-19 patients had significantly higher levels of the exhausted marker PD-1. Increasing PD-1 and Tim-3 expression on T cells was seen as patients progressed from prodromal to overtly symptomatic stages. Conclusions: T cell counts are reduced significantly in COVID-19 patients, and the surviving T cells appear functionally exhausted. Non-ICU patients with total T cells counts lower than 800/μL may still require urgent intervention, even in the immediate absence of more severe symptoms due to a high risk for further deterioration in condition.

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Journal

Journal ID (nlm-ta): J Clin Med

Journal ID (iso-abbrev): J Clin Med

Journal ID (publisher-id): jcm

Title: Journal of Clinical Medicine

Publisher: MDPI

ISSN (Electronic): 2077-0383

Publication date (Electronic): 28 October 2020

Publication date Collection: November 2020

Volume: 9

Issue: 11

Electronic Location Identifier: 3484

Affiliations

[1 ]Centro de Investigación Biomédica en Red-Cardiovascular (CIBER-CV), 28029 Madrid, Spain; elenaddll@ 123456gmail.com (E.d.D.); francisco.j.chorro@ 123456uv.es (F.J.C.)

[2 ]Medicine Department, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; Maria.Jose.Forner@ 123456uv.es

[3 ]Institute of Health Research-INCLIVA, 46010 Valencia, Spain; cesar_rios1@ 123456hotmail.com (C.R.-N.); neere_8@ 123456hotmail.com (N.P.-S.); jose_4_6_90@ 123456hotmail.com (J.G.); rodriguez_enr@ 123456gva.es (E.R.); carratala_art@ 123456gva.es (A.C.); jorgenavper@ 123456gmail.com (J.N.); blasco_luicor@ 123456gva.es (M.L.B.); jaimesignescosta@ 123456gmail.com (J.S.-C.); jose.m.salinas@ 123456uv.es (J.M.V.)

[4 ]Cardiology Department, Hospital Clínico Universitario, 46010 Valencia, Spain; vic_mg_cs@ 123456hotmail.com

[5 ]Biochemical Department, Hospital Clínico Universitario, 46010 Valencia, Spain

[6 ]Internal Medicine Department, Hospital Clínico Universitario, 46010 Valencia, Spain

[7 ]Medical Directory, Hospital Clínico Universitario, 46010 Valencia, Spain

[8 ]Medical Intensive Care Unit, Hospital Clínico Universitario, 46010 Valencia, Spain

[9 ]Pneumology Service, Hospital Clínico Universitario, 46010 Valencia, Spain; elvirabonre@ 123456gmail.com

[10 ]Physiology Department, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain

[11 ]Cardiovascular Medicine Unit, Center of Molecular Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, 171 77 Stockholm, Sweden; maria.forteza.de.los.reyes@ 123456ki.se

Author notes

[* ]Correspondence: vicente.bodi@ 123456uv.es ; Tel.: +34-96-197-3523

[†]

Both authors contributed equally.

Author information

Victor Marcos-Garces https://orcid.org/0000-0001-5565-5547

Enrique Rodríguez https://orcid.org/0000-0002-0339-6704

Arturo Carratalá https://orcid.org/0000-0003-4513-7214

Elvira Bondia https://orcid.org/0000-0001-6638-5466

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Publisher ID: jcm-09-03484

DOI: 10.3390/jcm9113484

PMC ID: 7692467

PubMed ID: 33126723

SO-VID: 939e1b07-9263-47f2-9cbb-a5c3adff1b2a

License:

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

Similar Clinical Course and Significance of Circulating Innate and Adaptive Immune Cell Counts in STEMI and COVID-19

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Novel Coronavirus Disease COVID-19

Most cited references 45

Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report

Reduction and Functional Exhaustion of T Cells in Patients With Coronavirus Disease 2019 (COVID-19)

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