Lymphopenia as a Biological Predictor of Outcomes in COVID-19 Patients: A Nationwide Cohort Study
1
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, The Catholic University of Korea, Seoul 06591, Korea
2
Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
3
Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
4
Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
*
Authors to whom correspondence should be addressed.
†
The first author: J.L., S.-S.P. and T.Y.K. contributed equally to this work as first authors.
Academic Editors: Gabriella D’Orazi and Mara Cirone
Cancers 2021, 13(3), 471; https://doi.org/10.3390/cancers13030471
Received: 28 November 2020
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Revised: 15 January 2021
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Accepted: 20 January 2021
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Published: 26 January 2021
(This article belongs to the Collection The Impact of COVID-19 Infection in Cancer)
Simple Summary
The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a major global health crisis. Owing to the rising number of cases and limited global resources, being able to predict patients with a severe disease course is crucial for the initial allocation of the limited medical resources. This study aimed to identify whether lymphopenia is a reliable prognostic marker for COVID-19 using Korean nationwide cohort. Lymphopenia and its severity levels may serve as reliable predictive factors for COVID-19 clinical outcomes including mortality, needs for intensive care, and oxygen requirements. Current study suggests that lymphopenia at the initial presentation of COVID-19 is associated with poor prognosis.
We aimed to identify whether lymphopenia is a reliable prognostic marker for COVID-19. Using data derived from a Korean nationwide longitudinal cohort of 5628 COVID-19 patients, we identified propensity-matched cohorts (n = 770) with group I of severe lymphopenia (absolute lymphocyte counts [ALC]: <500/mm3, n = 110), group II of mild-to-moderate lymphopenia (ALC: ≥500–<1000/mm3, n = 330), and group III, no lymphopenia (ALC: ≥1000/mm3, n = 330). A significantly higher mortality rate was associated with lymphopenia severity: 40% in group I, 22.7% in group II, and 13.0% in group III (p < 0.001). At 28 days, the estimated inferior overall survival associated with intensified lymphopenia: 62.7% in group I, 79.9% in group II, and 89.0% in group III (p < 0.001). Lymphopenia contributed significantly toward a greater need for interventions in all groups but at varying degrees: requirements of invasive ventilation, intensive oxygen supply, or adequate oxygen supply, respectively (p < 0.001). The lymphopenia intensity was independently associated with higher COVID-19 mortality in multivariable analysis; adjusted odds ratios of 5.63 (95% CI, 3.0–10.72), and 2.47 (95% CI, 1.5–4.13) for group I and group II, respectively. Lymphopenia and its severity levels may serve as reliable predictive factors for COVID-19 clinical outcomes; thus, lymphopenia may provide the prognostic granularity required for clinical use in the management of patients with COVID-19.
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Keywords:
COVID-19; SARS-CoV-2; mortality; prediction; lymphopenia
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MDPI and ACS Style
Lee, J.; Park, S.-S.; Kim, T.Y.; Lee, D.-G.; Kim, D.-W. Lymphopenia as a Biological Predictor of Outcomes in COVID-19 Patients: A Nationwide Cohort Study. Cancers 2021, 13, 471. https://doi.org/10.3390/cancers13030471
AMA Style
Lee J, Park S-S, Kim TY, Lee D-G, Kim D-W. Lymphopenia as a Biological Predictor of Outcomes in COVID-19 Patients: A Nationwide Cohort Study. Cancers. 2021; 13(3):471. https://doi.org/10.3390/cancers13030471
Chicago/Turabian StyleLee, Jongmin, Sung-Soo Park, Tong Y. Kim, Dong-Gun Lee, and Dong-Wook Kim. 2021. "Lymphopenia as a Biological Predictor of Outcomes in COVID-19 Patients: A Nationwide Cohort Study" Cancers 13, no. 3: 471. https://doi.org/10.3390/cancers13030471
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