Immunophenotyping characteristics and clinical outcome of COVID-19 patients treated with azvudine during the Omicron surge

Abstract

Background: Little is known about immunophenotyping characteristics and clinical outcomes of COVID-19 patients treated with azvudine during the Omicron variant surge.

Methods: This study enrolled patients diagnosed with COVID-19 from December 2022 to February 2023. The primary outcome was defined as all-cause mortality, along with a composite outcome reflecting disease progression. The enrolled patients were followed for a period of 60 days from their admission.

Results: A total of 268 COVID-19 patients treated with azvudine were enrolled in this retrospective study. The study found that the counts of lymphocyte subsets were significantly reduced in the composite outcome and all-cause mortality groups compared to the non-composite outcome and discharge groups (all p < 0.001). Correlation analysis revealed a negative association between lymphocyte subsets cell counts and inflammatory markers levels. The receiver operating characteristic (ROC) curve analysis identified low CD4⁺ T cell count as the most significant predictor of disease progression and all-cause mortality among the various lymphocyte subsets. Additionally, both the Kaplan-Meier curve and multivariate regression analysis demonstrated that low CD4⁺ T cell count level (< 156.00 cells/μl) was closely associated with all-cause mortality in COVID-19 patients treated with azvudine.

Conclusions: A low CD4⁺ T cell count may serve as a significant predictive indicator for identifying COVID-19 patients receiving azvudine treatment who are at an elevated risk of experiencing adverse outcomes. These findings may offer valuable insights for physicians in optimizing the administration of azvudine.

Keywords: CD4+ T cell; COVID-19; azvudine; lymphocyte subsets; mortality.

Figure 1

Lymphocyte subsets levels of COVID-19 patients with disease progression and final outcome. (A) Differences of lymphocyte subsets between non-composite outcome and composite outcome group. (B) Differences of lymphocyte subsets between discharge and mortality group. Red denotes composite outcome or mortality group; blue denotes non-composite outcome or discharge group.

Figure 2

Correlation analysis between lymphocyte subsets and clinical characteristics in COVID-19 patients. Red denotes positive correlation, blue denotes negative correlation, and blank denotes no statistical significance. WBC: white blood cell; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; BNP, brain natriuretic peptide.

Figure 3

ROC curves of lymphocyte subsets for the prediction of disease progression and all-cause mortality in COVID-19 patients during hospitalization. (A) ROC curves of lymphocyte subsets for the prediction of disease progression. (B) ROC curves of lymphocyte subsets for the prediction of all-cause mortality. ROC, receiver operating characteristic.

Figure 4

Kaplan-Meier analysis of the association between CD4⁺ T cell count level and the all-cause mortality in COVID-19 patients. Group A: CD4⁺ T cell count < 156.00 cells/μl; Group B: CD4⁺ T cell count ≥ 156.00 cells/μl.