Journal of Research in Applied and Basic Medical Sciences

en The CD4 cell level as a predictive factor for the outcome severity and prognosis of patients with COVID-19 Virology Virology پژوهشي orginal article <a name="_Hlk186014025"></a><a name="_Hlk184800267">Background & Aims</a>: Coronavirus disease 2019 (COVID-19) leads to the activation of immune cells, especially in patients developing severe disease, and induces lymphopenia, primarily affecting the cluster of differentiation 4 T-cell (CD4+ T) subset. The presence of lymphopenia and cytokine storm may play a major role in the pathogenesis of COVID-19. This prospective single-center study aimed to assess the association between CD4 cell levels and the severity and prognosis of COVID-19 pneumonia, comparing the differences in lymphocyte subsets and inflammatory biomarkers between severe and non-severe cases using flow cytometry. Materials & Methods: Between March 1 and June 30, 2020, a cohort of 122 RT-PCR-confirmed COVID-19 patients was enrolled in this prospective study. CD4 levels and other laboratory data were measured at the beginning of hospitalization. Results: Of the 122 patients, 56 were admitted to the respiratory ward and 66 to the ICU. ICU patients had significantly lower CD4 counts (368.93 cells/μL) compared to non-ICU patients (562.24 cells/μL) (P = 0.001). Serum C-reactive protein (CRP) levels were significantly higher in ICU patients (85.06 ± 41.85 mg/dL) than in non-ICU patients (57.29 ± 27.51 mg/dL) (P = 0.01), and a negative correlation was observed between CRP and CD4 levels (P = 0.03). Mortality was significantly higher in ICU patients (40.9%) compared to non-ICU patients (19.6%) (Odds Ratio = 2.83, P = 0.006). Conclusion: Our study demonstrates that lower CD4+ T-cell counts on admission are strongly associated with increased disease severity and poor prognosis in COVID-19 patients. The correlation between lower CD4 levels and higher CRP suggests that CD4+ T cell depletion may be a critical marker for predicting clinical outcomes. These findings highlight the potential role of CD4+ T-cell monitoring in managing severe COVID-19 cases and improving prognostic assessments. COVID-19, CD4 cell, Immune response, Inflammatory biomarkers, Lymphopenia 11 18 http://ijrabms.umsu.ac.ir/browse.php?a_code=A-10-134-10&slc_lang=en&sid=1 Shahin Keshtkar Rajabi keshtkat.sh@iums.ac.ir 10031947532846003861 10031947532846003861 No Firoozabadi clinical research development unit (FCRDU), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran Farshad Divsalar dr.farshaddivsalar@gmail.com 10031947532846003862 10031947532846003862 No Firoozgar General Hospital, Department of Infectious Disease, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran Fatemeh Montazer montazer.f@iums.ac.ir 10031947532846003863 10031947532846003863 No Firoozabadi clinical research development unit (FCRDU), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran Nogol Motamed-gorji nogol_motamed96@yahoo.com 10031947532846003864 10031947532846003864 No School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran Nima Azh nimaazh75@gmail.com 10031947532846003865 10031947532846003865 No School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran Mohammad Amin Abbasi amin.abbasi1314@gmail.com 10031947532846003866 0009-0004-8315-9507 Yes Firoozabadi clinical research development unit (FCRDU), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran