Immunological predictors of disease severity in patients with COVID-19

Asma Al Balushi*, Jalila AlShekaili, Mahmood Al Kindi, Zainab Ansari, Murtadha Al-Khabori, Faryal Khamis, Zaiyana Ambusaidi, Afra Al Balushi, Aisha Al Huraizi, Sumaiya Al Sulaimi, Fatma Al Fahdi, Iman Al Balushi, Nenad Pandak, Tom Fletcher, Iman Nasr*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)


Background: Identifying the immune cells involved in coronavirus disease 2019 (COVID-19) disease progression and the predictors of poor outcomes is important to manage patients adequately. Methods: This prospective observational cohort study enrolled 48 patients with COVID-19 hospitalized in a tertiary hospital in Oman and 53 non-hospitalized patients with confirmed mild COVID-19. Results: Hospitalized patients were older (58 years vs 36 years, P < 0.001) and had more comorbid conditions such as diabetes (65% vs 21% P < 0.001). Hospitalized patients had significantly higher inflammatory markers (P < 0.001): C-reactive protein (114 vs 4 mg/l), interleukin 6 (IL-6) (33 vs 3.71 pg/ml), lactate dehydrogenase (417 vs 214 U/l), ferritin (760 vs 196 ng/ml), fibrinogen (6 vs 3 g/l), D-dimer (1.0 vs 0.3 μg/ml), disseminated intravascular coagulopathy score (2 vs 0), and neutrophil/lymphocyte ratio (4 vs 1.1) (P < 0.001). On multivariate regression analysis, statistically significant independent early predictors of intensive care unit admission or death were higher levels of IL-6 (odds ratio 1.03, P = 0.03), frequency of large inflammatory monocytes (CD14+CD16+) (odds ratio 1.117, P = 0.010), and frequency of circulating naïve CD4+ T cells (CD27+CD28+CD45RA+CCR7+) (odds ratio 0.476, P = 0.03). Conclusion: IL-6, the frequency of large inflammatory monocytes, and the frequency of circulating naïve CD4 T cells can be used as independent immunological predictors of poor outcomes in COVID-19 patients to prioritize critical care and resources.
Original languageEnglish
Pages (from-to)83-92
Number of pages10
JournalInternational Journal of Infectious Diseases
Publication statusPublished - Sept 1 2021


  • COVID-19
  • Immunological predictors
  • Inflammatory markers
  • Lymphocyte subsets
  • Mortality predictors

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


Dive into the research topics of 'Immunological predictors of disease severity in patients with COVID-19'. Together they form a unique fingerprint.

Cite this