Immunosuppression as a Hallmark of Critical COVID-19: Prospective Study
Elżbieta Kalicińska,
Donata Szymczak,
Aleksander Zińczuk,
Barbara Adamik,
Jakub Smiechowicz,
Tomasz Skalec,
Danuta Nowicka-Suszko,
Monika Biernat,
Aleksandra Bogucka-Fedorczuk,
Justyna Rybka,
Adrian Martuszewski,
Waldemar Gozdzik,
Krzysztof Simon,
Tomasz Wróbel
Affiliations
Elżbieta Kalicińska
Department and Clinic of Hematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, 50-367 Wroclaw, Poland
Donata Szymczak
Department and Clinic of Hematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, 50-367 Wroclaw, Poland
Aleksander Zińczuk
Department of Infectious Diseases and Hepatology, Wroclaw Medical University, 51-149 Wroclaw, Poland
Barbara Adamik
Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, 50-556 Wroclaw, Poland
Jakub Smiechowicz
Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, 50-556 Wroclaw, Poland
Tomasz Skalec
Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, 50-556 Wroclaw, Poland
Danuta Nowicka-Suszko
Department of Dermatology and Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland
Monika Biernat
Department and Clinic of Hematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, 50-367 Wroclaw, Poland
Aleksandra Bogucka-Fedorczuk
Department and Clinic of Hematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, 50-367 Wroclaw, Poland
Justyna Rybka
Department and Clinic of Hematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, 50-367 Wroclaw, Poland
Adrian Martuszewski
Students Scientific Association, Department and Clinic of Hematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, 50-367 Wroclaw, Poland
Waldemar Gozdzik
Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, 50-556 Wroclaw, Poland
Krzysztof Simon
Department of Infectious Diseases and Hepatology, Wroclaw Medical University, 51-149 Wroclaw, Poland
Tomasz Wróbel
Department and Clinic of Hematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, 50-367 Wroclaw, Poland
The dysregulation of both the innate and adaptive responses to SARS-CoV-2 have an impact on the course of COVID-19, and play a role in the clinical outcome of the disease. Here, we performed a comprehensive analysis of peripheral blood lymphocyte subpopulations in 82 patients with COVID-19, including 31 patients with a critical course of the disease. In COVID-19 patients who required hospitalization we analyzed T cell subsets, including Treg cells, as well as TCRα/β and γ/δ, NK cells, and B cells, during the first two weeks after admission to hospital due to the SARS-CoV-2 infection, with marked reductions in leukocytes subpopulations, especially in critically ill COVID-19 patients. We showed decreased levels of Th, Ts cells, Treg cells (both naïve and induced), TCRα/β and γ/δ cells, as well as CD16+CD56+NK cells in ICU compared to non-ICU COVID-19 patients. We observed impaired function of T and NK cells in critically ill COVID-19 patients with extremely low levels of secreted cytokines. We found that the IL-2/INFγ ratio was the strongest indicator of a critical course of COVID-19, and was associated with fatal outcomes. Our findings showed markedly impaired innate and adaptive responses in critically ill COVID-19 patients, and suggest that the immunosuppressive state in the case of a critical course of SARS-CoV-2 infection might reflect subsequent clinical deterioration and predict a fatal outcome.
