Differences of blood cells, lymphocyte subsets and cytokines in COVID-19 patients with different clinical stages: a network meta-analysis

BackgroundDue to the rapid spread of coronavirus disease 2019 (COVID-19) worldwide, it is necessary to ascertain essential immune inflammatory parameters that describe the severity of the disease and provide guidance for treatment. We performed network meta-analyses to determine differences in blood cells, lymphocyte subsets, and cytokines in COVID-19 patients with different clinical stages.MethodsDatabases were systematically searched to May 2, 2020, and updated on June 1, 2020. Network meta-analyses were conducted via Stata 15.0, and the mean difference (MD) and its 95% CI were used as the effect values of the pooled analysis.ResultsSeventy-one studies were included involving 8647 COVID-19 patients, White blood cell (WBC), neutrophil (NEUT), IL-6, and IL-10 counts increased significantly with worsening of the COVID-19, while lymphocyte (LYM) counts decreased. The levels of platelet (PLT), CD3(+), CD4(+), CD8(+), and CD19(+) cells in severe and critical patients were significantly lower than those in mild patients. IL-1 beta count was significantly elevated in critical patients.ConclusionsImmune suppression and inflammatory injury play crucial roles in the progression of COVID-19, and the identification of susceptible cells and cytokines provide guidance for the early and accurate treatment of COVID-19 patients.

Automated summary

This study found that white blood cell, neutrophil, IL-6, and IL-10 counts increased significantly with worsening of COVID-19, while lymphocyte counts decreased. Platelet, CD3(+), CD4(+), CD8(+), and CD19(+) cell levels in severe and critical patients were significantly lower than those in mild patients. IL-1 beta count was significantly elevated in critical patients, indicating the crucial roles of immune suppression and inflammatory injury in the progression of COVID-19.