Clinical characteristics of asymptomatic carriers of novel coronavirus disease 2019: A multi-center study in Jiangsu Province

Abstract

Asymptomatic SARS-CoV-2-infected individuals are thought to play major roles in virus transmission. This study aimed to analyze the characteristics of asymptomatic carriers with COVID-19 to control the spread of the virus. We retrospectively investigated the clinical characteristics of 648 consecutive subjects who were enrolled in the study and were divided into asymptomatic carriers, mild cases, ordinary cases, severe or critical cases, and evaluated their impact on disease severity by means of Spearman correlation and multiple regression analyses. Receiver operating characteristic curve analysis was conducted to determine the optimum cutoff levels of laboratory findings for diagnostic predictors of asymptomatic carriers of COVID-19. In our study, a total of 648 subjects on admission with a mean age of 45.61 y including 345 males and 303 females were enrolled in our study. The leukocyte, lymphocyte, eosinophil, platelet, C-reactive protein, interleukin-6, CD3+, CD4+, and CD8 + T lymphocyte levels, and the erythrocyte sedimentation rate differed significantly among the groups (all p ≤ 0.05). Disease severity was negatively associated with the CD3+ (r = -0.340; p < 0.001), CD4+ (r = -0.290; p = 0.001) and CD8+ (r = -0.322; p < 0.001) T lymphocyte levels. The significant diagnostic predictors of asymptomatic carriers of COVID-19 included the blood cell, cytokine, and T lymphocyte subset levels. Inflammation and immune response may play important roles in disease progression. Hence, the laboratory parameters identified should be considered in clinical practice, which provide new insights into the identification of asymptomatic individuals and the prevention of virus transmission.

Keywords: COVID-19; Novel coronavirus disease-19; SARS-CoV-2; asymptomatic carriers; disease severity of COVID-19; immune response; inflammatory marker; severe acute respiratory syndrome coronavirus 2.

Figure 1.

Receiver operating characteristic curve analyses of leukocytes, lymphocytes, eosinophils, and platelets as diagnostic predictors of asymptomatic carriers of COVID-19. ROC: receiver operating characteristic; WBC: white blood cell; PLT: platelet

Figure 2.

Receiver operating characteristic curve analyses of interleukin-6 and procalcitonin as diagnostic predictors of asymptomatic asymptomatic carriers of COVID-19. ROC: receiver operating characteristic; IL-6: interleukin-6; PCT: procalcitonin

Figure 3.

Receiver operating characteristic curve analyses of aspartate aminotransferase, albumin, potassium, and sodium as diagnostic predictors of asymptomatic asymptomatic carriers of COVID-19. ROC: receiver operating characteristic; AST: aspartate aminotransferase; ALB: albumin; K: potassium; Na: sodium

Figure 4.

Receiver operating characteristic curve analyses of the activated partial thromboplastin time and fibrinogen as diagnostic predictors of asymptomatic asymptomatic carriers of COVID-19. ROC: receiver operating characteristic; APTT: activated partial thromboplastin time; FIB: fibrinogen

Figure 5.

Receiver operating characteristic curve analyses of cluster of differentiation (CD)3+, CD4+, and CD8+ lymphocyte levels as diagnostic predictors of asymptomatic asymptomatic carriers of COVID-19. ROC: receiver operating characteristic; CD: cluster of differentiation