Journal Article

Viral and host factors related to the clinical outcome of COVID-19

Chen, Bing, Xu, Mingzhu, Wang, Wei, Shi, Bisheng, Tan, Yun, Wang, Jinzeng, Zhao, Guoping, Liu, Feng, Wang, Shengyue, Zhang, Xinxin, Lu, Gang, Chen, Saijuan, Yuan, Zhenghong, Wu, Min, Xu, Shuibao, Lu, Hongzhou, Yi, Zhigang, Yu, Shuting, Zhang, Xiaonan, Chen, Jun, Zhang, Qin, Jiang, Lu, Ling, Yun, Jia, Xiaofang, Lu, Jing

2020

Overview

In December 2019, coronavirus disease 2019 (COVID-19), which is caused by the new coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in Wuhan (Hubei province, China) 1 ; it soon spread across the world. In this ongoing pandemic, public health concerns and the urgent need for effective therapeutic measures require a deep understanding of the epidemiology, transmissibility and pathogenesis of COVID-19. Here we analysed clinical, molecular and immunological data from 326 patients with confirmed SARS-CoV-2 infection in Shanghai. The genomic sequences of SARS-CoV-2, assembled from 112 high-quality samples together with sequences in the Global Initiative on Sharing All Influenza Data (GISAID) dataset, showed a stable evolution and suggested that there were two major lineages with differential exposure history during the early phase of the outbreak in Wuhan. Nevertheless, they exhibited similar virulence and clinical outcomes. Lymphocytopenia, especially reduced CD4 + and CD8 + T cell counts upon hospital admission, was predictive of disease progression. High levels of interleukin (IL)-6 and IL-8 during treatment were observed in patients with severe or critical disease and correlated with decreased lymphocyte count. The determinants of disease severity seemed to stem mostly from host factors such as age and lymphocytopenia (and its associated cytokine storm), whereas viral genetic variation did not significantly affect outcomes. Genome sequences from 112 patients with confirmed SARS-CoV-2 infection showed two clades of SARS-CoV-2 virus with similar virulence and clinical outcome, and clinical data from 326 cases suggest that T cell depletion and cytokine bursts are associated with a worse prognosis.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 45/23 / 631/326/596/4130 / 631/443/1784 / 692/699/255/2514 / Adolescent / Adult / Age / Aged / Aged, 80 and over / Aging / Animals / Asymptomatic / Asymptomatic Infections - epidemiology / Betacoronavirus - classification / Betacoronavirus - genetics / Betacoronavirus - isolation & purification / Betacoronavirus - pathogenicity / CD4 antigen / CD8 antigen / Cell number / China - epidemiology / Clinical outcomes / Cohort Studies / Comorbidity / Coronaviridae / Coronavirus Infections - complications / Coronavirus Infections - epidemiology / Coronavirus Infections - immunology / Coronavirus Infections - virology / Coronaviruses / COVID-19 / Critical Illness - epidemiology / Cytokine storm / Cytokines / Disease Progression / Disease transmission / Epidemiology / Evolution, Molecular / Female / Genetic aspects / Genetic diversity / Genetic Variation / Genome, Viral - genetics / Genomes / Genomics / Health aspects / Hospitalization - statistics & numerical data / Host-Pathogen Interactions - immunology / Host-virus relationships / Humanities and Social Sciences / Humans / Immunology / Infections / Inflammation Mediators - immunology / Influenza / Interleukin 8 / Interleukin-6 - blood / Interleukin-6 - immunology / Interleukin-8 - blood / Interleukin-8 - immunology / Lymphocyte Count / Lymphocytes / Lymphocytes T / Lymphopenia / Lymphopenia - complications / Lymphopenia - virology / Male / Middle Aged / multidisciplinary / Pandemics / Pathogenesis / Patient outcomes / Patients / Phylogeny / Pneumonia, Viral - complications / Pneumonia, Viral - epidemiology / Pneumonia, Viral - immunology / Pneumonia, Viral - virology / Public health / Respiratory diseases / Respiratory Distress Syndrome - complications / Respiratory Distress Syndrome - virology / SARS-CoV-2 / Science / Science (multidisciplinary) / Severe acute respiratory syndrome coronavirus 2 / T-Lymphocytes - cytology / T-Lymphocytes - immunology / Time Factors / Treatment Outcome / Viral diseases / Virulence / Virulence - genetics / Virus Shedding / Viruses / Young Adult / Zoonoses - transmission / Zoonoses - virology