Observational studyFrontiers in immunology2025
Innate and adaptive immune patterns in hospitalised COVID-19 patients: a framework for precision monitoring in viral and inflammatory syndromes.
Observational study in Frontiers in immunology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Understanding immune responses in viral infections such as COVID-19 is crucial for identifying patients at risk of clinical deterioration. Profiling innate and adaptive immune components may provide a basis for precision monitoring and personalised management strategies in infectious and inflammatory syndromes. Methods: In a prospective observational study, 150 patients were enrolled from 30 March to 15 April 2022, hospitalised for COVID-19 at a tertiary Internal Medicine COVID Unit. Flow cytometry analysis of peripheral blood quantified 34 immune subpopulations. Patients were stratified into immunophenotypic groups based on deficiencies in T helper (CD4), cytotoxic T (CD8), natural killer (NK), and plasma cells. Clinical outcomes were analysed in relation to these immune profiles using multivariate logistic regression. Results: Of the 150 patients (mean age 64.7 years, 59.1% male), 7.8% required ICU admission and 9.1% died. Lymphopenia (<1200 cells/µL) was observed in 84%, with 61.1% showing CD4+ T cell deficiency, 32.2% NK cell deficiency, 46% CD8+ T cell reduction, and 26.6% decreased plasma cells. Notably, 10% had concurrent CD4 and NK cell deficiencies. While low plasma cell counts were not associated with worse outcomes, NK cell deficiency was linked to a threefold increased risk of death or ICU transfer (OR 3.19, p<0.03), and CD4+ T cell reduction was associated with a 5.23-fold increase (p<0.037). The combination of low CD4 and NK cells resulted in a 9.5-fold higher risk of adverse outcome, independently of age and sex. Conclusions: Specific immune profiles, particularly reductions in CD4+ and NK cells, are strong predictors of mortality or ICU admission in hospitalized COVID-19 patients. These findings suggest that rapid and clinically feasible tool may support precision monitoring and personalised management in viral and inflammatory syndromes beyond COVID-19. This study advocates for the integration of immune profiling into the framework of precision medicine.
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