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Association of Early Inflammation with Age and Asymptomatic Disease in COVID-19

Authors Xie C, Li Q, Li L, Peng X, Ling Z, Xiao B, Feng J, Chen Z, Chang D, Xie L, Dela Cruz CS, Sharma L

Received 29 January 2021

Accepted for publication 11 March 2021

Published 30 March 2021 Volume 2021:14 Pages 1207—1216


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Professor Ning Quan

Chunmei Xie,1,* Qing Li,1,* Linhai Li,2,3,* Xiaohua Peng,4,5,* Zhijian Ling,1 Bin Xiao,3 Jingjing Feng,4,6 Zhenhong Chen,7 De Chang,2,8 Lixin Xie,2 Charles S Dela Cruz,4 Lokesh Sharma4

1Department of Blood Transfusion, Guangzhou 8th People’s Hospital, Guangzhou Medical University, Guangzhou, 510440, People’s Republic of China; 2College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, 100083, People’s Republic of China; 3Department of Laboratory Medicine, General Hospital of Southern Theatre Command of PLA, Guangzhou, 510010, People’s Republic of China; 4Section of Pulmonary and Critical Care and Sleep Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, 06520, USA; 5Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China; 6Department of Pulmonary and Critical Care Medicine, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, 200240, People’s Republic of China; 7Department of Pulmonary and Critical Care Medicine, Secondary Medical Center, Chinese PLA General Hospital, Beijing, 100083, People’s Republic of China; 8 Department of Pulmonary and Critical Care Medicine, Third Medical Center, Chinese PLA General Hospital, Beijing, 100039, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Lixin Xie; De Chang Email [email protected]; [email protected]

Background: Disease severity in COVID-19 ranges from asymptomatic infection to severe disease and death, especially in older subjects. The risk for severe infection and death has been reported to be 2X in those between 30 and 40 years, 3X in those between 40 and 50 years, and 4X in those between 50 and 65 years, compared to the reference group of 18– 29 years.
Objective: To investigate the early changes in host immune responses that are altered with age and the difference in the early host inflammatory response that dictates a symptomatic versus asymptomatic course of COVID-19.
Patients and Methods: COVID-19 subjects were identified by screening at the airport upon arrival from a foreign destination to China. Patients were either asymptomatic or had a mild disease when the first oro-pharyngeal (OP) swab samples were collected. Patients were quarantined and blood and throat swabs were collected during the course of the disease, allowing identification of the earliest host response to COVID-19. These patients were followed until their OP sample turned COVID-19 negative.
Results: Data were obtained from 126 PCR-confirmed COVID-19 patients. The blood samples were obtained within 48 days of qPCR confirmation of viral infection. Older subjects (> 30 years) had significantly elevated levels of anti-inflammatory cytokine IL-10, a significant decrease in the percentage of CD8+ T cells, and expansion in NKT cell fraction. This was associated with significantly elevated viral load and a delayed humoral response in older subjects. Compared to symptomatic subjects, asymptomatic patients had an early increase in pro-inflammatory cytokine IL-2, while a decrease in both T regulatory cells and anti-inflammatory cytokine IL-10. Further, asymptomatic disease was associated with early humoral response and faster viral clearance.
Conclusion: Early inflammatory response potentially plays a critical role for host-defense in COVID-19. The impaired early inflammatory response was associated with older age while a robust early inflammation was associated with asymptomatic disease.

Keywords: COVID-19, SARS-CoV-2, early inflammation, asymptomatic patient, elder patient

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