多项观察性研究报道了与COVID-19患者疾病严重程度和死亡率相关的异常免疫学指标。然而,在这些研究中,患者特征和研究方法存在明显的异质性。我们旨在提供免疫相关指标与COVID-19预后之间关联的最新综合。我们对PubMed进行了电子搜索,Scopus,奥维德,威利,WebofScience,科克伦图书馆,以及报告免疫和/或免疫相关参数的研究CNKI,包括血液学,炎症,凝血,和生化变量,对不同严重程度和结局的COVID-19患者的入院情况进行了测试。目前的荟萃分析共纳入145项研究,有26个免疫学,11血液学,5炎症,4凝固,报告了10个生化变量。其中,细胞因子的水平,包括IL-1β,IL-1Ra,IL-2R,IL-4、IL-6、IL-8、IL-10、IL-18、TNF-α、IFN-γ,IgA,IgG,和CD4+T/CD8+T细胞比率,WBC,中性粒细胞,血小板,ESR,CRP,铁蛋白,SAA,D-二聚体,FIB,在重症患者或非幸存者中,LDH显着增加。此外,非重症患者或幸存者的淋巴细胞计数明显更高,单核细胞,淋巴细胞/单核细胞比率,嗜酸性粒细胞,CD3+T,CD4+T和CD8+T细胞,B细胞,NK细胞目前更新的荟萃分析主要确定了高细胞因子血症谱与含IL-1β的COVID-19的严重程度和死亡率,IL-1Ra,IL-2R,IL-4、IL-6、IL-8、IL-10、IL-18、TNF-α、和IFN-γ。先天和适应性免疫反应受损,嗜酸性粒细胞减少,淋巴细胞,单核细胞,B细胞,NK细胞,T细胞,以及它们的亚型CD4+和CD8+T细胞,炎症加剧,凝血功能障碍,和非肺器官损伤,是预后不良患者的显著特征。因此,免疫反应功能障碍合并炎症的参数,凝固,或非肺器官损伤指标可能对预测重症患者和非幸存者更敏感。
Abnormal immunological indicators associated with disease severity and mortality in patients with COVID-19 have been reported in several observational studies. However, there are marked heterogeneities in patient characteristics and research methodologies in these studies. We aimed to provide an updated synthesis of the association between immune-related indicators and COVID-19 prognosis. We conducted an electronic search of PubMed, Scopus, Ovid, Willey, Web of Science, Cochrane library, and CNKI for studies reporting immunological and/or immune-related parameters, including hematological, inflammatory, coagulation, and biochemical variables, tested on hospital admission of COVID-19 patients with different severities and outcomes. A total of 145 studies were included in the current meta-analysis, with 26 immunological, 11 hematological, 5 inflammatory, 4 coagulation, and 10 biochemical variables reported. Of them, levels of cytokines, including IL-1β, IL-1Ra, IL-2R, IL-4, IL-6, IL-8, IL-10, IL-18, TNF-α, IFN-γ, IgA, IgG, and CD4+ T/CD8+ T cell ratio, WBC, neutrophil, platelet, ESR, CRP, ferritin, SAA, D-dimer, FIB, and LDH were significantly increased in severely ill patients or non-survivors. Moreover, non-severely ill patients or survivors presented significantly higher counts of lymphocytes, monocytes, lymphocyte/monocyte ratio, eosinophils, CD3+ T,CD4+T and CD8+T cells, B cells, and NK cells. The currently updated meta-analysis primarily identified a hypercytokinemia profile with the severity and mortality of COVID-19 containing IL-1β, IL-1Ra, IL-2R, IL-4, IL-6, IL-8, IL-10, IL-18, TNF-α, and IFN-γ. Impaired innate and adaptive immune responses, reflected by decreased eosinophils, lymphocytes, monocytes, B cells, NK cells, T cells, and their subtype CD4+ and CD8+ T cells, and augmented inflammation, coagulation dysfunction, and nonpulmonary organ injury, were marked features of patients with poor prognosis. Therefore, parameters of immune response dysfunction combined with inflammatory, coagulated, or nonpulmonary organ injury indicators may be more sensitive to predict severe patients and those non-survivors.