Association Between Lymphocyte Level and Severity of Coronavirus Disease 2019 Patients: A Cross-sectional Study in Indonesia
DOI:
https://doi.org/10.3889/oamjms.2022.8569Keywords:
COVID-19, Lymphocyte level, Severity, Predictor, IndonesiaAbstract
BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic has caused significant health problems globally. COVID-19 should be considered a systemic disease since it involves multiple systems, including the hematopoietic system and the immune system.
AIM: This study sought to determine the relationship between the lymphocyte levels and the severity of COVID-19 patients in Indonesia.
METHODS: A cross-sectional study was conducted among COVID-19 patients at Dr. Zainoel Abidin Hospital Banda Aceh Indonesia from August 27, to September 20, 2021. The subjects were recruited using consecutive sampling method and the data were obtained at their admission to the hospital. Chi-squared test was used to assess the association between lymphocyte levels and the severity of patients.
RESULTS: A total of 280 COVID-19 patients included of which 56.9% (91/160) of the patients with moderate severity, 76.1% (51/67) with a severe condition, and 84.9% (45/53) with critical severity had lymphopenia. There were no patients with lymphocytosis found in this study (0%). The Chi-squared test suggested that the lymphocyte level was significant associated with the severity of COVID-19 patients with p < 0.001.
CONCLUSION: Our study suggests that the lower the lymphocyte level, the higher the severity of COVID-19 patients. The level of lymphocyte is therefore potentially to be used as predictor for the disease severity and needs to be monitored regularly in COVID-19 patients.Downloads
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Fajar JK, Ilmawan M, Mamada S, Mutiawati E, Husnah M, Yusuf H, et al. Global prevalence of persistent neuromuscular symptoms and the possible pathomechanisms in COVID-19 recovered individuals: A systematic review and meta-analysis. Narra J 2021;1(3):e48. DOI: https://doi.org/10.52225/narra.v1i3.48
Fahriani M, Ilmawan M, Fajar JK, Maliga HA, Frediansyah A, Masyeni S, et al. Persistence of long COVID symptoms in COVID-19 survivors worldwide and its potential pathogenesis-a systematic review and meta-analysis. Narra J. 2021;1(2):e36. DOI: https://doi.org/10.52225/narraj.v1i2.36
Mudatsir M, Keam S, Winardi W, Yufika A, Rabaan AA, Rodriguez-Morales AJ, et al. Early transmission dynamics of SARS-CoV-2 in Indonesia. Trends Infect Global Health. 2021;1(1):1-6. DOI: https://doi.org/10.24815/tigh.v1i1.20134
Fahriani M, Anwar S, Yufika A, Bakhtiar B, Wardani E, Winardi W, et al. Disruption of childhood vaccination during the COVID-19 pandemic in Indonesia. Narra J. 2021;1(1):e7. DOI: https://doi.org/10.52225/narraj.v1i1.7
Machhi J, Herskovitz J, Senan AM, Dutta D, Nath B, Oleynikov MD, Blomberg WR, Meigs DD, Hasan M, Patel M. The natural history, pathobiology, and clinical manifestations of SARS-CoV-2 infections. J Neuroimmune Pharmacol. 2020;15(3):359-86. PMid:32696264 DOI: https://doi.org/10.1007/s11481-020-09944-5
Telles CR, Roy A, Ajmal MR, Mustafa SK, Ahmad MA, de la Serna JM, et al. The impact of COVID-19 management policies tailored to airborne SARS-CoV-2 transmission: Policy analysis. JMIR Public Health Surveill. 2021;7(4):e20699. https://doi.org/10.2196/20699 PMid:33729168 DOI: https://doi.org/10.2196/20699
Chung JY, Thone MN, Kwon YJ: COVID-19 vaccines: The status and perspectives in delivery points of view. Adv Drug Deliv Rev. 2021;170:1-25. https://doi.org/10.1016/j.addr.2020.12.011 PMid:33359141 DOI: https://doi.org/10.1016/j.addr.2020.12.011
Susilo A, Rumende CM, Pitoyo CW, Santoso WD, Yulianti M, Herikurniawan H, et al. Coronavirus disease 2019: Tinjauan literatur terkini. J Penyakit Dalam Indon. 2020; 7(1):45-67. DOI: https://doi.org/10.7454/jpdi.v7i1.415
Mustafa SK, Aljohani MM, Alomrani NA, Oyouni AA, Alzahrani O, Ahmad MA. COVID-19 and immune function-“a significant” zinc. Oriental J Chem. 2020;36(6):1026-36. DOI: https://doi.org/10.13005/ojc/360604
Huether SE, McCance KL: Buku Ajar Patofisiologi. 6th ed. Singapore: Elsevier; 2017.
Sherwood L. Fisiologi Manusia. 8th ed. Jakarta: EGC; 2017.
Terpos E, Ntanasis-Stathopoulos I, Elalamy I, Kastritis E, Sergentanis TN, Politou M, et al. Hematological findings and complications of COVID-19. Am J Hematol. 2020;95(7):834-47. https://doi.org/10.1002/ajh.25829 PMid:32282949 DOI: https://doi.org/10.1002/ajh.25829
Prakoeswa FR. Dasamuka COVID-19. Med Hosp J Clin Med. 2020;7(1A):231-40. DOI: https://doi.org/10.36408/mhjcm.v7i1A.457
PDPI. Revisi Protokol Tatalaksana COVID-19. Jakarta: PDPI, PERKI, PAPDI, PERDATIN, IDAI; 2021.
Mus R, Thaslifa T, Abbas M, Sunaidi Y. Studi literatur: Tinjauan pemeriksaan laboratorium pada pasien COVID-19. J Kesehatan Vokasional. 2020;5(4):242-52. DOI: https://doi.org/10.22146/jkesvo.58741
Ortiz-Prado E, Simbaña-Rivera K, Gómez-Barreno L, Rubio-Neira M, Guaman LP, Kyriakidis NC, et al. Clinical, molecular, and epidemiological characterization of the SARS-CoV-2 virus and the Coronavirus disease 2019 (COVID-19), a comprehensive literature review. Diagn Microbiol Infect Dis. 2020;98(1):115094. https://doi.org/10.1016/j.diagmicrobio.2020.115094 PMid:32623267 DOI: https://doi.org/10.1016/j.diagmicrobio.2020.115094
Wang J, Jiang M, Chen X, Montaner LJ. Cytokine storm and leukocyte changes in mild versus severe SARS-CoV-2 infection: Review of 3939 COVID-19 patients in China and emerging pathogenesis and therapy concepts. J Leukoc Biol. 2020;108(1):17-41. https://doi.org/10.1002/JLB.3COVR0520-272R PMid:32534467 DOI: https://doi.org/10.1002/JLB.3COVR0520-272R
Lee J, Park SS, Kim TY, Lee DG, Kim DW. 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 PMid:33530509 DOI: https://doi.org/10.3390/cancers13030471
Liu J, Li H, Luo M, Liu J, Wu L, Lin X, et al. Lymphopenia predicted illness severity and recovery in patients with COVID-19: A singlecenter, retrospective study. PLoS One. 2020;15(11):e0241659. https://doi.org/10.1371/journal.pone.0241659 PMid:33206680 DOI: https://doi.org/10.1371/journal.pone.0241659
Zhang JJ, Dong X, Cao YY, Yuan YD, Yang YB, Yan YQ, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020;75(7):1730-41. https://doi.org/10.1111/all.14238 PMid:32077115 DOI: https://doi.org/10.1111/all.14238
Magdalena M, Jane SY, Tantular R, Listyoko A. Clinical characteristics of COVID-19 patients in Dr Saiful Anwar Hospital Malang. J Respirologi Indones. 2021;41(1):1-11. DOI: https://doi.org/10.36497/jri.v41i1.150
Huang G, Kovalic AJ, Graber CJ. Prognostic value of leukocytosis and lymphopenia for coronavirus disease severity. Emerg Infect Dis. 2020;26(8):1839-41. https://doi.org/10.3201/eid2608.201160 PMid:32384045 DOI: https://doi.org/10.3201/eid2608.201160
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel Coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9. https://doi.org/10.1001/jama.2020.1585 PMid:32031570 DOI: https://doi.org/10.1001/jama.2020.1585
Sarengat R, Islam MS, Ardhi MS. Correlation of neutrophil-tolymphocyte ratio and clinical outcome of acute thrombotic stroke in patients with COVID-19. Narra J. 2021;1(3):e50. DOI: https://doi.org/10.52225/narra.v1i3.50
Wu C, Chen X, Cai Y, Zhou X, Xu S, Huang H, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-43. https://doi.org/10.1001/jamainternmed.2020.0994 PMid:32167524 DOI: https://doi.org/10.1001/jamainternmed.2020.0994
Zhang X, Tan Y, Ling Y, Lu G, Liu F, Yi Z, et al. Viral and host factors related to the clinical outcome of COVID-19. Nature. 2020;583(7816):437-40. https://doi.org/10.1038/s41586-020-2355-0 PMid:32434211 DOI: https://doi.org/10.1038/s41586-020-2355-0
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel Coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet. 2020;395(10223):507-13. https://doi.org/10.1016/S0140-6736(20)30211-7 PMid:32007143 DOI: https://doi.org/10.1016/S0140-6736(20)30211-7
Cummings MJ, Baldwin MR, Abrams D, Jacobson SD, Meyer BJ, Balough EM, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York city: A prospective cohort study. Lancet. 2020;395(10239):1763-70. https://doi.org/10.1016/S0140-6736(20)31189-2 PMid:32442528 DOI: https://doi.org/10.1016/S0140-6736(20)31189-2
Lagunas-Rangel FA, Chávez-Valencia V. High IL-6/IFN-γ ratio could be associated with severe disease in COVID-19 patients. J Med Virol. 2020;92(10):1789-90. https://doi.org/10.1002/jmv.25900 PMid:32297995 DOI: https://doi.org/10.1002/jmv.25900
Channappanavar R, Perlman S. Pathogenic human coronavirus infections: Causes and consequences of cytokine storm and immunopathology. Semin Immunopathol. 2017;39(5):529-539. https://doi.org/10.1007/s00281-017-0629-x PMid:28466096 DOI: https://doi.org/10.1007/s00281-017-0629-x
Tan L, Wang Q, Zhang D, Ding J, Huang Q, Tang YQ, et al. Lymphopenia predicts disease severity of COVID-19: A descriptive and predictive study. Signal Transduct Target Ther. 2020;5(1):33. https://doi.org/10.1038/s41392-020-0148-4 PMid:32296069 DOI: https://doi.org/10.1038/s41392-020-0159-1
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Copyright (c) 2022 Buchari Buchari, Hafni Andayani, Nadia Ayunda Putri (Author)
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