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Clinical Research and Public HealthIn-Press PreviewImmunologyInfectious disease Free access | 10.1172/JCI137244

Clinical and immunologic features in severe and moderate Coronavirus Disease 2019

Guang Chen,1 Di Wu,1 Wei Guo,1 Yong Cao,2 Da Huang,1 Hongwu Wang,1 Tao Wang,2 Xiaoyun Zhang,1 Huilong Chen,1 Haijing Yu,1 Xiaoping Zhang,1 Minxia Zhang,3 Shiji Wu,3 Jianxin Song,1 Tao Chen,1 Meifang Han,1 Shusheng Li,4 Xiaoping Luo,5 Jianping Zhao,2 and Qin Ning1

1Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

2Department of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

3Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

4Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

5Department of Pediatric Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

Find articles by Chen, G. in: JCI | PubMed | Google Scholar

1Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

2Department of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

3Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

4Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

5Department of Pediatric Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

Find articles by Wu, D. in: JCI | PubMed | Google Scholar

1Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

2Department of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

3Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

4Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

5Department of Pediatric Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

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1Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

2Department of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

3Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

4Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

5Department of Pediatric Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

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1Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

2Department of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

3Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

4Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

5Department of Pediatric Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

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1Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

2Department of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

3Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

4Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

5Department of Pediatric Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

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1Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

2Department of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

3Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

4Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

5Department of Pediatric Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

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1Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

2Department of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

3Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

4Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

5Department of Pediatric Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

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1Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

2Department of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

3Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

4Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

5Department of Pediatric Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

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1Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

2Department of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

3Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

4Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

5Department of Pediatric Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

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1Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

2Department of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

3Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

4Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

5Department of Pediatric Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

Find articles by Zhang, X. in: JCI | PubMed | Google Scholar

1Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

2Department of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

3Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

4Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

5Department of Pediatric Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

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1Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

2Department of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

3Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

4Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

5Department of Pediatric Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

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1Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

2Department of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

3Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

4Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

5Department of Pediatric Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

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1Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

2Department of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

3Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

4Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

5Department of Pediatric Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

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1Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

2Department of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

3Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

4Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

5Department of Pediatric Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

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1Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

2Department of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

3Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

4Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

5Department of Pediatric Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

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1Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

2Department of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

3Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

4Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

5Department of Pediatric Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

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1Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

2Department of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

3Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

4Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

5Department of Pediatric Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

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1Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

2Department of Respiratory Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

3Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

4Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

5Department of Pediatric Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and, Wuhan, China

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Published March 27, 2020 - More info

J Clin Invest. https://doi.org/10.1172/JCI137244.
Copyright © 2020, American Society for Clinical Investigation
Published March 27, 2020 - Version history
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Abstract

BACKGROUND. Since December 2019, an outbreak of Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, and is now becoming a global threat. We aimed to delineate and compare the immunologic features of severe and moderate COVID-19.

METHODS. In this retrospective study, the clinical and immunologic characteristics of 21 patients (17 male and 4 female) with COVID-19 were analyzed. These patients were classified as severe (11 cases) and moderate (10 cases) according to the Guidelines released by the National Health Commission of China.

RESULTS. The median age of severe and moderate cases was 61.0 and 52.0 years, respectively. Common clinical manifestations included fever, cough and fatigue. Compared to moderate cases, severe cases more frequently had dyspnea, lymphopenia, and hypoalbuminemia, with higher levels of alanine aminotransferase, lactate dehydrogenase, C-reactive protein, ferritin and D-dimer as well as markedly higher levels of IL-2R, IL-6, IL-10, and TNF-α. Absolute number of T lymphocytes, CD4+T and CD8+T cells decreased in nearly all the patients, and were markedly lower in severe cases (294.0, 177.5 and 89.0 × 106/L) than moderate cases (640.5, 381.5 and 254.0 × 106/L). The expressions of IFN-γ by CD4+T cells tended to be lower in severe cases (14.1%) than moderate cases (22.8%).

CONCLUSION. The SARS-CoV-2 infection may affect primarily T lymphocytes particularly CD4+T and CD8+ T cells, resulting in decrease in numbers as well as IFN-γ production. These potential immunological markers may be of importance due to their correlation with disease severity in COVID-19.

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  • Version 1 (March 27, 2020): In-Press Preview
  • Version 2 (April 13, 2020): Electronic publication
  • Version 3 (May 1, 2020): Print issue publication

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