Frontiers in medicine · 2026
Low CD3+ and CD4+ T cell levels predict need for ventilatory support and in-hospital mortality in patients with COVID-19: a retrospective cohort study.
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Martínez Ester Lobato, Moreno-Pérez Óscar, Otero-Rodríguez Silvia, García-Sevila Raquel, Marco-de-la-Calle Francisco, Sánchez-Martínez Rosario, Merino-de-Lucas Esperanza, Ramos-Rincón José-Manuel
Аннотация
OBJECTIVES: The aim of the following study is to determine the association between lymphocyte subsets (total lymphocytes, CD3, CD4, CD8, B cells, NK cells) and clinical outcomes (need for non-invasive ventilatory support, ICU admission and in-hospital death) in patients hospitalized with SARS-CoV-2 infection.
METHODS: We conducted a single-center, pre-vaccination, retrospective cohort study including adults hospitalized between March 2020 and April 2021. Peripheral blood samples were collected within the first 24 h of admission for immune phenotyping. Additional clinical data were obtained from electronic health records. Statistical analyses included chi-square tests and multivariable logistic regression, adjusted for clinical characteristics and inflammatory biomarkers. Optimal cutoff points for immune and inflammatory markers were determined using the Youden index.
RESULTS: Among 959 patients, 29.4% required ventilatory support, 11.3% required ICU admission, and 10.7% died. In multivariable analysis adjusted by clinical and laboratory confounders, CD3+ cells (cutoff point: 666 cells/mm3) were independently associated with ventilatory support (aOR: 2.3, 95%CI: 1.5-3.4, p = 0.013) and in-hospital death (aOR: 2.4, 95%CI: 1.3-4.3, p = 0.048); and CD4+ cells (cutoff point: 359 cells/mm3) were independently associated with in-hospital death (aOR: 2.8, 95%CI: 1.4-5.5, p = 0.045).
CONCLUSION: Adaptive immunity, especially T CD3+ and T CD4+ cells, is relevant in the prognosis of COVID-19, and T-cell counts can help identify hospitalized COVID-19 patients at risk for severe outcomes: ventilatory support and in-hospital death.
METHODS: We conducted a single-center, pre-vaccination, retrospective cohort study including adults hospitalized between March 2020 and April 2021. Peripheral blood samples were collected within the first 24 h of admission for immune phenotyping. Additional clinical data were obtained from electronic health records. Statistical analyses included chi-square tests and multivariable logistic regression, adjusted for clinical characteristics and inflammatory biomarkers. Optimal cutoff points for immune and inflammatory markers were determined using the Youden index.
RESULTS: Among 959 patients, 29.4% required ventilatory support, 11.3% required ICU admission, and 10.7% died. In multivariable analysis adjusted by clinical and laboratory confounders, CD3+ cells (cutoff point: 666 cells/mm3) were independently associated with ventilatory support (aOR: 2.3, 95%CI: 1.5-3.4, p = 0.013) and in-hospital death (aOR: 2.4, 95%CI: 1.3-4.3, p = 0.048); and CD4+ cells (cutoff point: 359 cells/mm3) were independently associated with in-hospital death (aOR: 2.8, 95%CI: 1.4-5.5, p = 0.045).
CONCLUSION: Adaptive immunity, especially T CD3+ and T CD4+ cells, is relevant in the prognosis of COVID-19, and T-cell counts can help identify hospitalized COVID-19 patients at risk for severe outcomes: ventilatory support and in-hospital death.