• Jing Liu, Sumeng Li, Jia Liu, Boyun Liang, Xiaobei Wang, Hua Wang, Wei Li, Qiaoxia Tong, Jianhua Yi, Lei Zhao, Lijuan Xiong, Chunxia Guo, Jin Tian, Jinzhuo Luo, Jinghong Yao, Ran Pang, Hui Shen, Cheng Peng, Ting Liu, Qian Zhang, Jun Wu, Ling Xu, Sihong Lu, Baoju Wang, Zhihong Weng, Chunrong Han, Huabing Zhu, Ruxia Zhou, Helong Zhou, Xiliu Chen, Pian Ye, Bin Zhu, Lu Wang, Wenqing Zhou, Shengsong He, Yongwen He, Shenghua Jie, Ping Wei, Jianao Zhang, Yinping Lu, Weixian Wang, Li Zhang, Ling Li, Fengqin Zhou, Jun Wang, Ulf Dittmer, Mengji Lu, Yu Hu, Dongliang Yang, and Xin Zheng.
• Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Joint International Laboratory of Infection and Immunity, Huazhong University of Science and Technology, Wuhan 430022, China.
• EBioMedicine. 2020 May 1; 55: 102763.

BackgroundThe dynamic changes of lymphocyte subsets and cytokines profiles of patients with novel coronavirus disease (COVID-19) and their correlation with the disease severity remain unclear.MethodsPeripheral blood samples were longitudinally collected from 40 confirmed COVID-19 patients and examined for lymphocyte subsets by flow cytometry and cytokine profiles by specific immunoassays.FindingsOf the 40 COVID-19 patients enrolled, 13 severe cases showed significant and sustained decreases in lymphocyte counts [0·6 (0·6-0·8)] but increases in neutrophil counts [4·7 (3·6-5·8)] than 27 mild cases [1.1 (0·8-1·4); 2·0 (1·5-2·9)]. Further analysis demonstrated significant decreases in the counts of T cells, especially CD8+ T cells, as well as increases in IL-6, IL-10, IL-2 and IFN-γ levels in the peripheral blood in the severe cases compared to those in the mild cases. T cell counts and cytokine levels in severe COVID-19 patients who survived the disease gradually recovered at later time points to levels that were comparable to those of the mild cases. Moreover, the neutrophil-to-lymphocyte ratio (NLR) (AUC=0·93) and neutrophil-to-CD8+ T cell ratio (N8R) (AUC =0·94) were identified as powerful prognostic factors affecting the prognosis for severe COVID-19.InterpretationThe degree of lymphopenia and a proinflammatory cytokine storm is higher in severe COVID-19 patients than in mild cases, and is associated with the disease severity. N8R and NLR may serve as a useful prognostic factor for early identification of severe COVID-19 cases.FundingThe National Natural Science Foundation of China, the National Science and Technology Major Project, the Health Commission of Hubei Province, Huazhong University of Science and Technology, and the Medical Faculty of the University of Duisburg-Essen and Stiftung Universitaetsmedizin, Hospital Essen, Germany.Copyright © 2020 The Author(s). Published by Elsevier B.V. All rights reserved.

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