Original Article

Differential alteration trend of white blood cells (WBCs) and monocytes count in severe and non-severe COVID-19 patients within a 7-day follow-up

Abstract

Background and Objectives: Several studies have focused on the alterations of hematological parameters for a better understanding of the COVID-19 pathogenesis and also their potential for predicting disease prognosis and severity. Although some evidence has indicated the prognostic values of thrombocytopenia, neutrophilia, and lymphopenia, there are conflicting results concerning the leukocyte and monocyte count.
Materials and Methods: In this retrospective Double­ Centre study, we reviewed the results of WBC and monocyte counts of 1320 COVID-19 patients (243 of whom (18.4%) had severe disease) both on admission and within a 7-day follow-up.
Results: We found that both the number of monocytes and the percentage of monocytosis were higher in the severe group; however, it was not statistically significant. On the other hand, we found that not only the mean number of WBCs was significantly higher in the severe cases also leukocytosis was a common finding in this group; indicating that an increased number of WBC may probably predict a poor prognosis. Also, the monocyte count was not affected by age; however, univariate analysis showed that the percentage of leukocytosis was significantly greater in the older group (>50) with an odds ratio of 1.71 (P: 0.003).
Conclusion: Alteration of monocytes either on admission or within hospitalization would not provide valuable data about the prediction of COVID-19 prognosis. Although the rapidly evolving nature of COVID-19 is the major limitation of the present study, further investigations in the field of laboratory biomarkers will pave the way to manage patients with severe disease better.

1. Lu H, Stratton CW, Tang YW. The Wuhan SARS‐CoV‐2–What's next for China. J Med Virol 2020;92: 546-547.
2. Richman DD, Whitley RJ, Hayden FG (2016). Clinical Virology. 4th ed. ASM press; Washington DC.
3. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020;323: 1239-1242.
4. Du Y, Tu L, Zhu P, Mu M, Wang R, Yang P, et al. Clinical features of 85 fatal cases of COVID-19 from Wuhan. A retrospective observational study. Am J Respir Crit Care Med 2020;201:1372-1379.
5. Yang Y, Shen C, Li J, Yuan J, Yang M, Wang F, et al. Exuberant elevation of IP-10, MCP-3 and IL-1ra during SARS-CoV-2 infection is associated with disease severity and fatal outcome. medRxiv 2020: 10.1101/2020.03.02.20029975.
6. Xiong Y, Liu Y, Cao L, Wang D, Guo M, Jiang A, et al. Transcriptomic characteristics of bronchoalveolar lavage fluid and peripheral blood mononuclear cells in COVID-19 patients. Emerg Microbes Infect 2020;9: 761-770.
7. Wang T, Du Z, Zhu F, Cao Z, An Y, Gao Y, et al. Comorbidities and multi-organ injuries in the treatment of COVID-19. Lancet 2020;395(10228):e52.
8. Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020;5: 811-818.
9. Perisetti A, Gajendran M, Mann R, Elhanafi S, Goyal H. COVID-19 extrapulmonary illness – special gastrointestinal and hepatic considerations. Dis Mon 2020; 66: 101064.
10. Lippi G, Plebani M. Laboratory abnormalities in patients with COVID-2019 infection. Clin Chem Lab Med 2020;58: 1131-1134.
11. Lu G, Wang J. Dynamic changes in routine blood parameters of a severe COVID-19 case. Clin Chim Act 2020;508: 98-102.
12. Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis. Clin Chim Acta 2020;506: 145-148.
13. Yang X, Yang Q, Wang Y, Wu Y, Xu J, Yu Y, et al. Thrombocytopenia and its association with mortality in patients with COVID‐19. J Thromb Haemost 2020;18: 1469-1472.
14. Yuan J, Zou R, Zeng L, Kou S, Lan J, Li X, et al. The correlation between viral clearance and biochemical outcomes of 94 COVID-19 infected discharged patients. Inflamm Res 2020: 69:599-606.
15. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395: 497-506.
16. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323: 1061-1069.
17. Zhou Y, Fu B, Zheng X, Wang D, Zhao C, Qi Y, et al. Pathogenic T-cells and inflammatory monocytes incite inflammatory storms in severe COVID-19 patients. Natl Sci Rev 2020;7: 998-1002.
18. Zhang D, Guo R, Lei L, Liu H, Wang Y, Wang Y, et al. COVID-19 infection induces readily detectable morphological and inflammation-related phenotypic changes in peripheral blood monocytes, the severity of which correlate with patient outcome. J Leukoc Biol 2020;10.1002/JLB.4HI0720-470R.
19. Liu J, Li S, Liu J, Liang B, Wang X, Wang H, et al. Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients. EBioMedicine 2020;55: 102763.
20. Sanchez-Cerrillo I, Landete P, Aldave B, Sanchez-Alonso S, Sanchez-Azofra A, Marcos-Jimenez A, et al. Differential redistribution of activated monocyte and dendritic cell subsets to the lung associates with severity of COVID-19. medRxiv 2020: 10.1101/2020.05.13.20100925.
21. Singh A, Sood N, Narang V, Goyal A. Morphology of COVID-19–affected cells in peripheral blood film. BMJ Case Rep 2020;13(5): e236117.
22. Pence BD. Severe COVID-19 and aging: are monocytes the key? GeroScience 2020;42:1051-1061.
23. Gómez-Rial J, Rivero-Calle I, Salas A, Martinón-Torres F. Role of monocytes/macrophages in Covid-19 pathogenesis: implications for therapy. Infect Drug Resist 2020;13:2485-2493.
24. Lichtman MA, Kaushansky K, Prchal JT, Levi MM, Burns LJ, Armitage J (2017). Williams manual of hematology. 9th ed. McGraw-Hill Education/Medical; New York City.
25. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020;8: 420-422.
26. Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis 2020;20: 425-434.
27. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395: 507-513.
28. Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020;395: 809-815.
29. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395: 1054-1062.
30. Chen L, Liu H, Liu W, Liu J, Liu K, Shang J, et al. [Analysis of clinical features of 29 patients with 2019 novel coronavirus pneumonia]. Zhonghua Jie He He Hu Xi Za Zhi 2020;43(0):E005.
31. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA 2020;323: 1061-1069.
Files
IssueVol 13 No 1 (2021) QRcode
SectionOriginal Article(s)
Published2021-02-10
DOI https://doi.org/10.18502/ijm.v13i1.5486
Keywords
COVID-19; Follow-up studies; Prognosis; Monocyte; Leukocytosis

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Pirsalehi A, Salari S, Baghestani A, Sanadgol G, Shirini D, Moghbel Baerz M, Abdi S, Akbari ME, Bashash D. Differential alteration trend of white blood cells (WBCs) and monocytes count in severe and non-severe COVID-19 patients within a 7-day follow-up. Iran J Microbiol. 13(1):8-16.