Identification of Parameters Representative of Immune Dysfunction in Patients with Severe and Fatal COVID-19 Infection: a Systematic Review and Meta-analysis.

IF 8.4 2区 医学 Q1 ALLERGY Clinical Reviews in Allergy & Immunology Pub Date : 2023-02-01 Epub Date: 2022-01-18 DOI:10.1007/s12016-021-08908-8
Rundong Qin, Li He, Zhaowei Yang, Nan Jia, Ruchong Chen, Jiaxing Xie, Wanyi Fu, Hao Chen, Xinliu Lin, Renbin Huang, Tian Luo, Yukai Liu, Siyang Yao, Mei Jiang, Jing Li
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Abstract

Abnormal immunological indicators associated with disease severity and mortality in patients with COVID-19 have been reported in several observational studies. However, there are marked heterogeneities in patient characteristics and research methodologies in these studies. We aimed to provide an updated synthesis of the association between immune-related indicators and COVID-19 prognosis. We conducted an electronic search of PubMed, Scopus, Ovid, Willey, Web of Science, Cochrane library, and CNKI for studies reporting immunological and/or immune-related parameters, including hematological, inflammatory, coagulation, and biochemical variables, tested on hospital admission of COVID-19 patients with different severities and outcomes. A total of 145 studies were included in the current meta-analysis, with 26 immunological, 11 hematological, 5 inflammatory, 4 coagulation, and 10 biochemical variables reported. Of them, levels of cytokines, including IL-1β, IL-1Ra, IL-2R, IL-4, IL-6, IL-8, IL-10, IL-18, TNF-α, IFN-γ, IgA, IgG, and CD4+ T/CD8+ T cell ratio, WBC, neutrophil, platelet, ESR, CRP, ferritin, SAA, D-dimer, FIB, and LDH were significantly increased in severely ill patients or non-survivors. Moreover, non-severely ill patients or survivors presented significantly higher counts of lymphocytes, monocytes, lymphocyte/monocyte ratio, eosinophils, CD3+ T,CD4+T and CD8+T cells, B cells, and NK cells. The currently updated meta-analysis primarily identified a hypercytokinemia profile with the severity and mortality of COVID-19 containing IL-1β, IL-1Ra, IL-2R, IL-4, IL-6, IL-8, IL-10, IL-18, TNF-α, and IFN-γ. Impaired innate and adaptive immune responses, reflected by decreased eosinophils, lymphocytes, monocytes, B cells, NK cells, T cells, and their subtype CD4+ and CD8+ T cells, and augmented inflammation, coagulation dysfunction, and nonpulmonary organ injury, were marked features of patients with poor prognosis. Therefore, parameters of immune response dysfunction combined with inflammatory, coagulated, or nonpulmonary organ injury indicators may be more sensitive to predict severe patients and those non-survivors.

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确定严重和致命 COVID-19 感染患者免疫功能失调的代表性参数:系统回顾和 Meta 分析。
一些观察性研究报告了与 COVID-19 患者疾病严重程度和死亡率相关的异常免疫指标。然而,这些研究在患者特征和研究方法上存在明显的异质性。我们旨在对免疫相关指标与 COVID-19 预后之间的关系进行最新综述。我们在 PubMed、Scopus、Ovid、Willey、Web of Science、Cochrane library 和 CNKI 上进行了电子检索,以寻找报道不同严重程度和预后的 COVID-19 患者入院时检测的免疫和/或免疫相关参数(包括血液学、炎症、凝血和生化变量)的研究。本次荟萃分析共纳入了 145 项研究,报告了 26 个免疫学变量、11 个血液学变量、5 个炎症变量、4 个凝血变量和 10 个生化变量。其中,细胞因子水平,包括 IL-1β、IL-1Ra、IL-2R、IL-4、IL-6、IL-8、IL-10、IL-18、TNF-α、IFN-γ、IgA、IgG 和 CD4+ T/CD8+ T 细胞比率、白细胞、中性粒细胞、血小板、血沉、CRP、铁蛋白、SAA、D-二聚体、FIB 和 LDH 在重症患者或非存活者中显著增加。此外,非重症患者或幸存者的淋巴细胞、单核细胞、淋巴细胞/单核细胞比值、嗜酸性粒细胞、CD3+T、CD4+T 和 CD8+T 细胞、B 细胞和 NK 细胞的数量也明显增加。目前更新的荟萃分析主要确定了高细胞血症与 COVID-19 的严重程度和死亡率的关系,其中包括 IL-1β、IL-1Ra、IL-2R、IL-4、IL-6、IL-8、IL-10、IL-18、TNF-α 和 IFN-γ。嗜酸性粒细胞、淋巴细胞、单核细胞、B 细胞、NK 细胞、T 细胞及其亚型 CD4+ 和 CD8+ T 细胞减少,炎症、凝血功能障碍和非肺器官损伤加重,反映出先天性和适应性免疫反应受损,是预后不良患者的显著特征。因此,免疫反应功能障碍参数与炎症、凝血或非肺器官损伤指标相结合,可能对预测重症患者和非存活患者更为敏感。
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来源期刊
CiteScore
22.30
自引率
1.10%
发文量
58
审稿时长
6-12 weeks
期刊介绍: Clinical Reviews in Allergy & Immunology is a scholarly journal that focuses on the advancement of clinical management in allergic and immunologic diseases. The journal publishes both scholarly reviews and experimental papers that address the current state of managing these diseases, placing new data into perspective. Each issue of the journal is dedicated to a specific theme of critical importance to allergists and immunologists, aiming to provide a comprehensive understanding of the subject matter for a wide readership. The journal is particularly helpful in explaining how novel data impacts clinical management, along with advancements such as standardized protocols for allergy skin testing and challenge procedures, as well as improved understanding of cell biology. Ultimately, the journal aims to contribute to the improvement of care and management for patients with immune-mediated diseases.
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