Immunological Biomarkers of Fatal COVID-19: A Study of 868 Patients
Information on the immunopathobiology of coronavirus disease 2019 (COVID-19) is rapidly increasing; however, there remains a need to identify immune features predictive of fatal outcome. This large-scale study characterized immune responses to severe acute respiratory syndrome coronavirus-2 (SARS-Co...
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Format: | Article |
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Frontiers Media S.A.
2021-05-01
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Series: | Frontiers in Immunology |
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Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2021.659018/full |
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author |
Esperanza Martín-Sánchez Esperanza Martín-Sánchez Esperanza Martín-Sánchez Esperanza Martín-Sánchez Juan José Garcés Juan José Garcés Juan José Garcés Juan José Garcés Catarina Maia Catarina Maia Catarina Maia Catarina Maia Susana Inogés Susana Inogés Susana Inogés Ascensión López-Díaz de Cerio Ascensión López-Díaz de Cerio Ascensión López-Díaz de Cerio Francisco Carmona-Torre Francisco Carmona-Torre Francisco Carmona-Torre Marta Marin-Oto Félix Alegre Elvira Molano Mirian Fernandez-Alonso Mirian Fernandez-Alonso Cristina Perez Cristina Perez Cristina Perez Cirino Botta Aintzane Zabaleta Aintzane Zabaleta Aintzane Zabaleta Aintzane Zabaleta Ana Belen Alcaide Manuel F. Landecho Marta Rua Teresa Pérez-Warnisher Laura Blanco Laura Blanco Sarai Sarvide Sarai Sarvide Sarai Sarvide Amaia Vilas-Zornoza Amaia Vilas-Zornoza Amaia Vilas-Zornoza Diego Alignani Diego Alignani Diego Alignani Diego Alignani Cristina Moreno Cristina Moreno Cristina Moreno Iñigo Pineda Miguel Sogbe Josepmaria Argemi Bruno Paiva Bruno Paiva Bruno Paiva Bruno Paiva José Ramón Yuste José Ramón Yuste José Ramón Yuste |
spellingShingle |
Esperanza Martín-Sánchez Esperanza Martín-Sánchez Esperanza Martín-Sánchez Esperanza Martín-Sánchez Juan José Garcés Juan José Garcés Juan José Garcés Juan José Garcés Catarina Maia Catarina Maia Catarina Maia Catarina Maia Susana Inogés Susana Inogés Susana Inogés Ascensión López-Díaz de Cerio Ascensión López-Díaz de Cerio Ascensión López-Díaz de Cerio Francisco Carmona-Torre Francisco Carmona-Torre Francisco Carmona-Torre Marta Marin-Oto Félix Alegre Elvira Molano Mirian Fernandez-Alonso Mirian Fernandez-Alonso Cristina Perez Cristina Perez Cristina Perez Cirino Botta Aintzane Zabaleta Aintzane Zabaleta Aintzane Zabaleta Aintzane Zabaleta Ana Belen Alcaide Manuel F. Landecho Marta Rua Teresa Pérez-Warnisher Laura Blanco Laura Blanco Sarai Sarvide Sarai Sarvide Sarai Sarvide Amaia Vilas-Zornoza Amaia Vilas-Zornoza Amaia Vilas-Zornoza Diego Alignani Diego Alignani Diego Alignani Diego Alignani Cristina Moreno Cristina Moreno Cristina Moreno Iñigo Pineda Miguel Sogbe Josepmaria Argemi Bruno Paiva Bruno Paiva Bruno Paiva Bruno Paiva José Ramón Yuste José Ramón Yuste José Ramón Yuste Immunological Biomarkers of Fatal COVID-19: A Study of 868 Patients Frontiers in Immunology COVID-19 SARS-CoV-2 flow cytometry lymphopenia outcome survival |
author_facet |
Esperanza Martín-Sánchez Esperanza Martín-Sánchez Esperanza Martín-Sánchez Esperanza Martín-Sánchez Juan José Garcés Juan José Garcés Juan José Garcés Juan José Garcés Catarina Maia Catarina Maia Catarina Maia Catarina Maia Susana Inogés Susana Inogés Susana Inogés Ascensión López-Díaz de Cerio Ascensión López-Díaz de Cerio Ascensión López-Díaz de Cerio Francisco Carmona-Torre Francisco Carmona-Torre Francisco Carmona-Torre Marta Marin-Oto Félix Alegre Elvira Molano Mirian Fernandez-Alonso Mirian Fernandez-Alonso Cristina Perez Cristina Perez Cristina Perez Cirino Botta Aintzane Zabaleta Aintzane Zabaleta Aintzane Zabaleta Aintzane Zabaleta Ana Belen Alcaide Manuel F. Landecho Marta Rua Teresa Pérez-Warnisher Laura Blanco Laura Blanco Sarai Sarvide Sarai Sarvide Sarai Sarvide Amaia Vilas-Zornoza Amaia Vilas-Zornoza Amaia Vilas-Zornoza Diego Alignani Diego Alignani Diego Alignani Diego Alignani Cristina Moreno Cristina Moreno Cristina Moreno Iñigo Pineda Miguel Sogbe Josepmaria Argemi Bruno Paiva Bruno Paiva Bruno Paiva Bruno Paiva José Ramón Yuste José Ramón Yuste José Ramón Yuste |
author_sort |
Esperanza Martín-Sánchez |
title |
Immunological Biomarkers of Fatal COVID-19: A Study of 868 Patients |
title_short |
Immunological Biomarkers of Fatal COVID-19: A Study of 868 Patients |
title_full |
Immunological Biomarkers of Fatal COVID-19: A Study of 868 Patients |
title_fullStr |
Immunological Biomarkers of Fatal COVID-19: A Study of 868 Patients |
title_full_unstemmed |
Immunological Biomarkers of Fatal COVID-19: A Study of 868 Patients |
title_sort |
immunological biomarkers of fatal covid-19: a study of 868 patients |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Immunology |
issn |
1664-3224 |
publishDate |
2021-05-01 |
description |
Information on the immunopathobiology of coronavirus disease 2019 (COVID-19) is rapidly increasing; however, there remains a need to identify immune features predictive of fatal outcome. This large-scale study characterized immune responses to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection using multidimensional flow cytometry, with the aim of identifying high-risk immune biomarkers. Holistic and unbiased analyses of 17 immune cell-types were conducted on 1,075 peripheral blood samples obtained from 868 COVID-19 patients and on samples from 24 patients presenting with non-SARS-CoV-2 infections and 36 healthy donors. Immune profiles of COVID-19 patients were significantly different from those of age-matched healthy donors but generally similar to those of patients with non-SARS-CoV-2 infections. Unsupervised clustering analysis revealed three immunotypes during SARS-CoV-2 infection; immunotype 1 (14% of patients) was characterized by significantly lower percentages of all immune cell-types except neutrophils and circulating plasma cells, and was significantly associated with severe disease. Reduced B-cell percentage was most strongly associated with risk of death. On multivariate analysis incorporating age and comorbidities, B-cell and non-classical monocyte percentages were independent prognostic factors for survival in training (n=513) and validation (n=355) cohorts. Therefore, reduced percentages of B-cells and non-classical monocytes are high-risk immune biomarkers for risk-stratification of COVID-19 patients. |
topic |
COVID-19 SARS-CoV-2 flow cytometry lymphopenia outcome survival |
url |
https://www.frontiersin.org/articles/10.3389/fimmu.2021.659018/full |
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doaj-c15b9c99870b4f74b9865fe9dd3e5c422021-05-03T05:35:25ZengFrontiers Media S.A.Frontiers in Immunology1664-32242021-05-011210.3389/fimmu.2021.659018659018Immunological Biomarkers of Fatal COVID-19: A Study of 868 PatientsEsperanza Martín-Sánchez0Esperanza Martín-Sánchez1Esperanza Martín-Sánchez2Esperanza Martín-Sánchez3Juan José Garcés4Juan José Garcés5Juan José Garcés6Juan José Garcés7Catarina Maia8Catarina Maia9Catarina Maia10Catarina Maia11Susana Inogés12Susana Inogés13Susana Inogés14Ascensión López-Díaz de Cerio15Ascensión López-Díaz de Cerio16Ascensión López-Díaz de Cerio17Francisco Carmona-Torre18Francisco Carmona-Torre19Francisco Carmona-Torre20Marta Marin-Oto21Félix Alegre22Elvira Molano23Mirian Fernandez-Alonso24Mirian Fernandez-Alonso25Cristina Perez26Cristina Perez27Cristina Perez28Cirino Botta29Aintzane Zabaleta30Aintzane Zabaleta31Aintzane Zabaleta32Aintzane Zabaleta33Ana Belen Alcaide34Manuel F. Landecho35Marta Rua36Teresa Pérez-Warnisher37Laura Blanco38Laura Blanco39Sarai Sarvide40Sarai Sarvide41Sarai Sarvide42Amaia Vilas-Zornoza43Amaia Vilas-Zornoza44Amaia Vilas-Zornoza45Diego Alignani46Diego Alignani47Diego Alignani48Diego Alignani49Cristina Moreno50Cristina Moreno51Cristina Moreno52Iñigo Pineda53Miguel Sogbe54Josepmaria Argemi55Bruno Paiva56Bruno Paiva57Bruno Paiva58Bruno Paiva59José Ramón Yuste60José Ramón Yuste61José Ramón Yuste62Hematology Department, Clínica Universidad de Navarra, Pamplona, SpainHemato-Oncology Department, Centro de Investigación Médica Aplicada (CIMA), Pamplona, SpainHemato-Oncology Department, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, SpainCentro de Investigación Biomédica en Red, Pamplona, SpainHematology Department, Clínica Universidad de Navarra, Pamplona, SpainHemato-Oncology Department, Centro de Investigación Médica Aplicada (CIMA), Pamplona, SpainHemato-Oncology Department, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, SpainCentro de Investigación Biomédica en Red, Pamplona, SpainHematology Department, Clínica Universidad de Navarra, Pamplona, SpainHemato-Oncology Department, Centro de Investigación Médica Aplicada (CIMA), Pamplona, SpainHemato-Oncology Department, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, SpainCentro de Investigación Biomédica en Red, Pamplona, SpainCentro de Investigación Biomédica en Red, Pamplona, SpainImmunology and Immunotherapy Department, Clínica Universidad de Navarra, Pamplona, SpainHematology Service and Cell Therapy Area, Clínica Universidad de Navarra, Pamplona, SpainCentro de Investigación Biomédica en Red, Pamplona, SpainImmunology and Immunotherapy Department, Clínica Universidad de Navarra, Pamplona, SpainHematology Service and Cell Therapy Area, Clínica Universidad de Navarra, Pamplona, SpainInternal Medicine Department, Clínica Universidad de Navarra, Pamplona, SpainDivision of Infectious Diseases, Clínica Universidad de Navarra, Pamplona, SpainImmune and Infectious Inflammatory Diseases Research, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain0Neumology Department, Clínica Universidad de Navarra, Pamplona, SpainInternal Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain1Internal Medicine Department, Clínica Universidad de Navarra, Madrid, SpainImmune and Infectious Inflammatory Diseases Research, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain2Microbiology Department, Clínica Universidad de Navarra, Pamplona, SpainHemato-Oncology Department, Centro de Investigación Médica Aplicada (CIMA), Pamplona, SpainHemato-Oncology Department, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, SpainCentro de Investigación Biomédica en Red, Pamplona, Spain3Hematology Department, Hospital “Annunziata”, Cosenza, ItalyHematology Department, Clínica Universidad de Navarra, Pamplona, SpainHemato-Oncology Department, Centro de Investigación Médica Aplicada (CIMA), Pamplona, SpainHemato-Oncology Department, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, SpainCentro de Investigación Biomédica en Red, Pamplona, Spain0Neumology Department, Clínica Universidad de Navarra, Pamplona, SpainInternal Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain2Microbiology Department, Clínica Universidad de Navarra, Pamplona, Spain4Neumology Department, Clínica Universidad de Navarra, Madrid, SpainHemato-Oncology Department, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, SpainCentro de Investigación Biomédica en Red, Pamplona, SpainHemato-Oncology Department, Centro de Investigación Médica Aplicada (CIMA), Pamplona, SpainHemato-Oncology Department, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, SpainCentro de Investigación Biomédica en Red, Pamplona, SpainHemato-Oncology Department, Centro de Investigación Médica Aplicada (CIMA), Pamplona, SpainHemato-Oncology Department, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, SpainCentro de Investigación Biomédica en Red, Pamplona, SpainHematology Department, Clínica Universidad de Navarra, Pamplona, SpainHemato-Oncology Department, Centro de Investigación Médica Aplicada (CIMA), Pamplona, SpainHemato-Oncology Department, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, SpainCentro de Investigación Biomédica en Red, Pamplona, SpainHematology Department, Clínica Universidad de Navarra, Pamplona, SpainHemato-Oncology Department, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, SpainCentro de Investigación Biomédica en Red, Pamplona, SpainInternal Medicine Department, Clínica Universidad de Navarra, Pamplona, SpainInternal Medicine Department, Clínica Universidad de Navarra, Pamplona, SpainInternal Medicine Department, Clínica Universidad de Navarra, Pamplona, SpainHematology Department, Clínica Universidad de Navarra, Pamplona, SpainHemato-Oncology Department, Centro de Investigación Médica Aplicada (CIMA), Pamplona, SpainHemato-Oncology Department, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, SpainCentro de Investigación Biomédica en Red, Pamplona, SpainInternal Medicine Department, Clínica Universidad de Navarra, Pamplona, SpainDivision of Infectious Diseases, Clínica Universidad de Navarra, Pamplona, SpainImmune and Infectious Inflammatory Diseases Research, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, SpainInformation on the immunopathobiology of coronavirus disease 2019 (COVID-19) is rapidly increasing; however, there remains a need to identify immune features predictive of fatal outcome. This large-scale study characterized immune responses to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection using multidimensional flow cytometry, with the aim of identifying high-risk immune biomarkers. Holistic and unbiased analyses of 17 immune cell-types were conducted on 1,075 peripheral blood samples obtained from 868 COVID-19 patients and on samples from 24 patients presenting with non-SARS-CoV-2 infections and 36 healthy donors. Immune profiles of COVID-19 patients were significantly different from those of age-matched healthy donors but generally similar to those of patients with non-SARS-CoV-2 infections. Unsupervised clustering analysis revealed three immunotypes during SARS-CoV-2 infection; immunotype 1 (14% of patients) was characterized by significantly lower percentages of all immune cell-types except neutrophils and circulating plasma cells, and was significantly associated with severe disease. Reduced B-cell percentage was most strongly associated with risk of death. On multivariate analysis incorporating age and comorbidities, B-cell and non-classical monocyte percentages were independent prognostic factors for survival in training (n=513) and validation (n=355) cohorts. Therefore, reduced percentages of B-cells and non-classical monocytes are high-risk immune biomarkers for risk-stratification of COVID-19 patients.https://www.frontiersin.org/articles/10.3389/fimmu.2021.659018/fullCOVID-19SARS-CoV-2flow cytometrylymphopeniaoutcomesurvival |