Along with PaO2/FiO2 ratio and lymphopenia, low HLA-DR monocytes are the only additional parameter that independently predicts the clinical course of undifferentiated SARS-CoV-2 patients in emergency departments

• Published in: Journal of leukocyte biology Vol. 115; no. 6; pp. 1131 - 1142
• Main Authors: Lafon, Thomas, Chapuis, Nicolas, Guerin, Estelle, Daix, Thomas, Otranto, Marcela, Boumediene, Ahmed, Jeannet, Robin, Fontenay, Michaela, Henri Hani, Karam, Vignon, Philippe, Monneret, Guillaume, François, Bruno, Jean-Philippe, Jais, Feuillard, Jean
• Format: Journal Article
• Language: English
• Published: England 29-05-2024
• Subjects: Adult; Aged; Aged, 80 and over; Biomarkers - blood; COVID-19 - blood; COVID-19 - immunology; COVID-19 - pathology; Emergency Service, Hospital; Female; HLA-DR Antigens; Humans; Lymphopenia - blood; Lymphopenia - immunology; Male; Middle Aged; Monocytes - immunology; Monocytes - metabolism; Monocytes - pathology; Oxygen - blood; Prognosis; Prospective Studies; SARS-CoV-2 - immunology; HLA-DR; monocytes; COVID-19 deterioration
• ISSN: 1938-3673; 1938-3673
• DOI: 10.1093/jleuko/qiae022

Because one-third of patients deteriorate after their admission to the emergency department, assessing the prognosis of COVID-19 patients is of great importance. However, to date, only lymphopenia and the partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio have been reported as partly predictive of COVID-19-related further deterioration, and their association has not been evaluated. We asked whether other key biomarkers of SARS-CoV-2 immunologic defects-increase in circulating immature granulocytes, loss of monocyte HLA-DR (mHLA-DR) expression, and monocyte differentiation blockade-could also predict further COVID-19 deterioration. A series of 284 consecutive COVID-19 patients, with the sole inclusion criterion of being an adult, were prospectively enrolled at emergency department admission (day 0) of 2 different hospitals: 1 for the exploratory cohort (180 patients) and 1 for the confirmatory cohort (104 patients). Deterioration was assessed over the next 7 days. Neither increased immature granulocyte levels nor monocyte differentiation blockade predicted patient worsening. Among more than 30 clinical, biological, and radiological parameters, the value of decreased P/F ratio and lymphopenia for prediction of further COVID-19 deterioration was strongly confirmed, and the loss of mHLA-DR was the only additional independent marker. Combined together in a simple OxyLymphoMono score, the 3 variables perfectly predicted patients who did not worsen and correctly predicted worsening in 59% of cases. By highlighting lymphocyte and monocyte defects as preceding COVID-19 deterioration, these results point on early immunosuppression in COVID-19 deterioration. Combining P/F ratio, lymphopenia, and loss of mHLA-DR together in a simple and robust score could offer a pragmatic method for COVID-19 patient stratification.