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Abarca-Zabalía J, González-Jiménez A, Calle-Rubio M, López-Pastor AR, Fariña T, Ramos-Acosta C, Anguita E, Urcelay E, Espino-Paisán L. Alterations in the immune system persist after one year of convalescence in severe COVID-19 patients. Front Immunol 2023; 14:1127352. [PMID: 36860856 PMCID: PMC9969554 DOI: 10.3389/fimmu.2023.1127352] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/25/2023] [Indexed: 02/16/2023] Open
Abstract
Introduction Severe COVID-19 originates a myriad of alterations in the immune system during active disease, especially in the T and NK cell compartments, but several studies in the last year have unveiled some alterations that persist in convalescence. Although most of the studies follow the participants for a short recovery time, studies following patients up to three or six months still find alterations. We aimed at evaluating changes in the NK, T and B cell compartments after severe COVID-19 in participants with a median recovery time of eleven months. Methods Eighteen convalescent of severe COVID-19 (CSC), 14 convalescent of mild COVID-19 (CMC) and nine controls were recruited. NKG2A, NKG2C, NKG2D and the activating receptor NKp44 were evaluated in NKbright, NKdim and NKT subpopulations. In addition, CD3 and CD19 were measured and a basic biochemistry with IL-6 levels was obtained. Results CSC participants showed lower NKbright/NKdim ratio, higher NKp44 expression in NKbright subpopulations, higher levels of serum IL-6, lower levels of NKG2A+ T lymphocytes and a trend to a lower expression of CD19 in B lymphocytes compared to controls. CMC participants showed no significant alterations in the immune system compared to controls. Conclusions These results are concordant with previous studies, which find alterations in CSC weeks or months after resolution of the symptoms, and point to the possibility of these alterations lasting one year or more after COVID-19 resolution.
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Affiliation(s)
- Judith Abarca-Zabalía
- Laboratorio de Investigación en Genética de Enfermedades Complejas, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Adela González-Jiménez
- Laboratorio de Investigación en Genética de Enfermedades Complejas, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Myriam Calle-Rubio
- Department of Pneumology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Andrea R. López-Pastor
- Laboratorio de Investigación en Genética de Enfermedades Complejas, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain,*Correspondence: Andrea R. López-Pastor,
| | - Tomás Fariña
- Intensive Care Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Carlos Ramos-Acosta
- Department of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain,Hematology Department, Instituto de Medicina de Laboratorio, Instituto de Investigación Sanitaria San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Eduardo Anguita
- Department of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain,Hematology Department, Instituto de Medicina de Laboratorio, Instituto de Investigación Sanitaria San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Elena Urcelay
- Laboratorio de Investigación en Genética de Enfermedades Complejas, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Laura Espino-Paisán
- Laboratorio de Investigación en Genética de Enfermedades Complejas, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Sánchez-Montalvá A, Álvarez-Sierra D, Martínez-Gallo M, Perurena-Prieto J, Arrese-Muñoz I, Ruiz-Rodríguez JC, Espinosa-Pereiro J, Bosch-Nicolau P, Martínez-Gómez X, Antón A, Martínez-Valle F, Riveiro-Barciela M, Blanco-Grau A, Rodríguez-Frias F, Castellano-Escuder P, Poyatos-Canton E, Bas-Minguet J, Martínez-Cáceres E, Sánchez-Pla A, Zurera-Egea C, Teniente-Serra A, Hernández-González M, Pujol-Borrell R. Exposing and Overcoming Limitations of Clinical Laboratory Tests in COVID-19 by Adding Immunological Parameters; A Retrospective Cohort Analysis and Pilot Study. Front Immunol 2022; 13:902837. [PMID: 35844497 PMCID: PMC9276968 DOI: 10.3389/fimmu.2022.902837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Two years since the onset of the COVID-19 pandemic no predictive algorithm has been generally adopted for clinical management and in most algorithms the contribution of laboratory variables is limited. Objectives To measure the predictive performance of currently used clinical laboratory tests alone or combined with clinical variables and explore the predictive power of immunological tests adequate for clinical laboratories. Methods: Data from 2,600 COVID-19 patients of the first wave of the pandemic in the Barcelona area (exploratory cohort of 1,579, validation cohorts of 598 and 423 patients) including clinical parameters and laboratory tests were retrospectively collected. 28-day survival and maximal severity were the main outcomes considered in the multiparametric classical and machine learning statistical analysis. A pilot study was conducted in two subgroups (n=74 and n=41) measuring 17 cytokines and 27 lymphocyte phenotypes respectively. Findings 1) Despite a strong association of clinical and laboratory variables with the outcomes in classical pairwise analysis, the contribution of laboratory tests to the combined prediction power was limited by redundancy. Laboratory variables reflected only two types of processes: inflammation and organ damage but none reflected the immune response, one major determinant of prognosis. 2) Eight of the thirty variables: age, comorbidity index, oxygen saturation to fraction of inspired oxygen ratio, neutrophil-lymphocyte ratio, C-reactive protein, aspartate aminotransferase/alanine aminotransferase ratio, fibrinogen, and glomerular filtration rate captured most of the combined statistical predictive power. 3) The interpretation of clinical and laboratory variables was moderately improved by grouping them in two categories i.e., inflammation related biomarkers and organ damage related biomarkers; Age and organ damage-related biomarker tests were the best predictors of survival, and inflammatory-related ones were the best predictors of severity. 4) The pilot study identified immunological tests (CXCL10, IL-6, IL-1RA and CCL2), that performed better than most currently used laboratory tests. Conclusions Laboratory tests for clinical management of COVID 19 patients are valuable but limited predictors due to redundancy; this limitation could be overcome by adding immunological tests with independent predictive power. Understanding the limitations of tests in use would improve their interpretation and simplify clinical management but a systematic search for better immunological biomarkers is urgent and feasible.
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Affiliation(s)
- Adrián Sánchez-Montalvá
- Infectious Disease Department, Hospital Universitari Vall Hebron, Barcelona, Spain
- International Health Program Institut Català de la Salut, Vall Hebron Research Institute (VHIR), Barcelona, Spain
- Department of Medicine, Universitat Autònoma Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Barcelona, Spain
| | - Daniel Álvarez-Sierra
- Translational Immunology Research Group, Vall Hebron Research Institute (VHIR), Barcelona, Spain
| | - Mónica Martínez-Gallo
- Translational Immunology Research Group, Vall Hebron Research Institute (VHIR), Barcelona, Spain
- Immunology Department, Hospital Universitari Vall Hebron, Barcelona, Spain
- Department of Cell Biology, Physiology, and Immunology, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Janire Perurena-Prieto
- Translational Immunology Research Group, Vall Hebron Research Institute (VHIR), Barcelona, Spain
- Department of Cell Biology, Physiology, and Immunology, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Iria Arrese-Muñoz
- Immunology Department, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - Juan Carlos Ruiz-Rodríguez
- Intensive Medicine Department, Hospital Universitari Vall Hebron, Barcelona, Spain
- Organ Dysfunction and Resuscitation Research Group, Vall Hebron Research Institute (VHIR), Barcelona, Spain
| | - Juan Espinosa-Pereiro
- Infectious Disease Department, Hospital Universitari Vall Hebron, Barcelona, Spain
- International Health Program Institut Català de la Salut, Vall Hebron Research Institute (VHIR), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Barcelona, Spain
| | - Pau Bosch-Nicolau
- Infectious Disease Department, Hospital Universitari Vall Hebron, Barcelona, Spain
- International Health Program Institut Català de la Salut, Vall Hebron Research Institute (VHIR), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Barcelona, Spain
| | - Xavier Martínez-Gómez
- Epidemiology and Public Health Department, Hospital Universitari Vall Hebron, Barcelona, Spain
- Epidemiology and Public Health Research Group, Vall Hebron Research Institute (VHIR), Barcelona, Spain
- Department of Pediatrics, Obstetrics and Gynecology, Epidemiology and Public Health, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Andrés Antón
- Microbiology Department, Hospital Universitari Vall Hebron, Barcelona, Spain
- Microbiology Research Group, Vall Hebron Research Institute (VHIR), Barcelona, Spain
- Department of Genetics and Microbiology, Autonomous University of Barcelona, Barcelona, Spain
| | - Ferran Martínez-Valle
- Department of Medicine, Universitat Autònoma Barcelona, Barcelona, Spain
- Internal Medicine Department, Hospital Universitari Vall Hebron, Barcelona, Spain
- Systemic Disease Research Group, Valle Hebron Research Institute (VHIR), Barcelona, Spain
| | - Mar Riveiro-Barciela
- Department of Medicine, Universitat Autònoma Barcelona, Barcelona, Spain
- Liver Disease Research Group, Valle Hebron Research Institute (VHIR), Barcelona, Spain
- CIBERehd - Instituto de Salud Carlos III, Barcelona, Spain
| | - Albert Blanco-Grau
- Clinical Biochemistry Department, Hospital Universitari Vall d'Hebron and Clinical Biochemistry Research Group, Valle Hebron Research Institute (VHIR), Barcelona, Spain
| | - Francisco Rodríguez-Frias
- Clinical Biochemistry Department, Hospital Universitari Vall d'Hebron and Clinical Biochemistry Research Group, Valle Hebron Research Institute (VHIR), Barcelona, Spain
| | | | - Elisabet Poyatos-Canton
- Immunology Division, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Bas-Minguet
- Immunology Division, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - Eva Martínez-Cáceres
- Department of Cell Biology, Physiology, and Immunology, Universitat Autònoma Barcelona, Barcelona, Spain
- Immunology Group, Germans Trias i Pujol Health Sciences Research Institute (IGTP), Badalona (Barcelona), Spain
- Immunology Department, Hospital Universitari Germans Trias Pujol, Badalona (Barcelona), Spain
| | - Alex Sánchez-Pla
- Bioinformatics and Statistics Group, University of Barcelona, Barcelona, Spain
- Statistics and Bioinformatics Unit, Vall Hebron Research Institute (VHIR), Barcelona, Spain
| | - Coral Zurera-Egea
- Immunology Department, Hospital Universitari Germans Trias Pujol, Badalona (Barcelona), Spain
| | - Aina Teniente-Serra
- Department of Cell Biology, Physiology, and Immunology, Universitat Autònoma Barcelona, Barcelona, Spain
- Immunology Group, Germans Trias i Pujol Health Sciences Research Institute (IGTP), Badalona (Barcelona), Spain
- Immunology Department, Hospital Universitari Germans Trias Pujol, Badalona (Barcelona), Spain
| | - Manuel Hernández-González
- Translational Immunology Research Group, Vall Hebron Research Institute (VHIR), Barcelona, Spain
- Immunology Department, Hospital Universitari Vall Hebron, Barcelona, Spain
- Department of Cell Biology, Physiology, and Immunology, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Ricardo Pujol-Borrell
- Translational Immunology Research Group, Vall Hebron Research Institute (VHIR), Barcelona, Spain
- Immunology Department, Hospital Universitari Vall Hebron, Barcelona, Spain
- Department of Cell Biology, Physiology, and Immunology, Universitat Autònoma Barcelona, Barcelona, Spain
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