Table 1.
Clinical and immunological characteristics of patients with COVID-19.
| Non-lethal courses of COVID-19 |
Lethal courses of COVID-19 |
|||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| MedStar Georgetown Transplant Institute Liver Patients | SUNY Control Patients | MedStar Georgetown Transplant Institute Liver Patients | SUNY Control Patients | |||||||
| Demographics | ||||||||||
| Age, years | 49 | 55 | 65 | 65 | 48–75 | 70 | 46 | 65 | 61 | 57–77 |
| Sex, M/F | F | M | F | F | 1M, 3F | F | M | F | M | 2M, 2F |
| Race, white (W) or non-white (NW) | NW | NW | W | NW | 1W, 3NW | W | W | NW | NW | 0W, 4NW |
| Key comorbidities, n | 2 | 3 | 3 | 5 | 2–3 | 1 | 2 | 3 | 3 | 1–3 |
| Diabetes | ✓ | 4 of 4 | ✓ | ✓ | ✓ | 1 of 4 | ||||
| Obesity | ✓ | ✓ | ✓ | ✓ | 2 of 4 | ✓ | 2 of 4 | |||
| Hypertension | ✓ | ✓ | 4 of 4 | ✓ | ✓ | 4 of 4 | ||||
| Heart disease | ✓ | ✓ | ✓ | 0 of 4 | ✓ | 2 of 4 | ||||
| Active liver disease | ✓ | ✓ | ✓ | 0 of 4 | ✓ | ✓ | 0 of 4 | |||
| Transplant/liver disease status | ||||||||||
| Transplanted organ type | Liver & Kidney | n.a. | Liver | Liver | Liver & Kidney | n.a. | ||||
| Underlying liver disease | ETOH cirrhosis | ETOH cirrhosis | NAFLD, ALF |
AIH cirrhosis | n.a. | ETOH cirrhosis | HCV, ETOH cirrhosis | PSC cirrhosis | ETOH cirrhosis | n.a. |
| COVID-19 outcome | ||||||||||
| Hospitalization | ✓ | ✓ | ✓ | ✓ | 4 of 4 | ✓ | ✓ | ✓ | ✓ | 4 of 4 |
| Supplemental O2 | ✓ | ✓ | 3 of 4 | ✓ | ✓ | ✓ | ✓ | 4 of 4 | ||
| Intubation/ICU | ✓ | ✓ | 2 of 4 | ✓ | ✓ | ✓ | 4 of 4 | |||
| No discharge by day 14 | ✓ | 3 of 4 | ✓ | ✓ | ✓ | ✓ | 4 of 4 | |||
| Death | 0 of 4 | ✓ | ✓ | ✓ | ✓ | 4 of 4 | ||||
| Liver function tests | ||||||||||
| AST (U/L) [3-34], upon presentation | 45 | 86 | 9654 | 76 | 12–88 | 61 | 99 | 19 | 40 | 17–175 |
| AST, highest value during hospitalization | 45 | 86 | 9654 | 136 | 18–158 | 64 | 233 | 74 | 178 | 117–5147 |
| ALT (U/L) [15-41], upon presentation | 73 | 55 | 3714 | 43 | 21–89 | 27 | 77 | 27 | 35 | 9–126 |
| ALT, highest value during hospitalization | 73 | 55 | 3714 | 79 | 21–197 | 36 | 111 | 89 | 147 | 87–5,658 |
| Total bilirubin (mg/dl) [0.2-1.3], upon presentation | 0.3 | 5.4 | 1.8 | 0.6 | 0.3–0.6 | 0.6 | 26.3 | 0.8 | 0.6 | 0.4–3.7 |
| Total bilirubin, highest value during hospitalization | 0.3 | 5.4 | 1.8 | 0.9 | 0.3–1.3 | 2.1 | 30.8 | 0.8 | 1.4 | 1.0–4.3 |
| ALP (U/L) [45-117], upon presentation | 254 | 324 | 243 | 254 | 63–95 | 182 | 699 | 72 | 80 | 61–143 |
| ALP, highest value during hospitalization | 378 | 324 | 319 | 455 | 63–156 | 182 | 699 | 102 | 633 | 129–195 |
| Inflammatory markers | ||||||||||
| LDH (U/L) [84-246], upon presentation | 246 | 337 | 957 | 388 | 603–685 | 176 | 352 | 411 | 685 | 217–1,919 |
| LDH, highest value during hospitalization | 286 | 368 | 957 | 488 | 723–746 | 190 | 388 | 411 | 685 | 579–1,919 |
| CRP (mg/L) [0.0-3.0], upon presentation | 43.0 | 11.5 | 53.3 | 96.2 | 97–338 | 3.4 | 31.4 | 145 | 79 | 100–271 |
| CRP, highest value during hospitalization | 43.0 | 31.9 | 53.3 | 296.0 | 150–461 | 5.4 | 101.0 | 228.0 | 181.0 | 100–342 |
| Ferritin (ng/ml) [5.0-148.0], upon presentation | 1432 | 56.8 | 211.1 | 258.9 | 410–2,120 | 1,527 | 2,941 | 2,238 | 544.2 | 233–20,956 |
| Ferritin, highest value during hospitalization | 1432 | 113 | 238 | 439 | 1,355–2,120 | 1,527 | 4,585 | 2,754 | 607 | 2,707–20,956 |
| D-dimer (μg/ml FEU) [<0.65], upon presentation | 4.35 | 1.44 | >20 | 1.92 | 0.5–8.0 | 2.43 | 5.71 | 11.55 | 0.5 | n.a. |
| D-dimer, highest value during hospitalization | 4.35 | 1.44 | >20 | 3.56 | 1.0–>8.0 | 2.43 | 5.71 | 16.37 | 7.62 | n.a. |
| Immunomonitoring | ||||||||||
| WBC (K/μl) [4.0-10.8], upon presentation | 9.9 | 6.9 | 17.4 | 3.7 | 5.8–13.4 | 2.7 | 4.2 | 8.0 | 3.6 | 4.6–16.1 |
| WBC (K/μl), lowest value during hospitalization | 2.3 | 5.2 | 5.9 | 3.7 | 5.1–9.2 | 2.7 | 4.2 | 4.8 | 3.6 | 2.3–8.5 |
| Lymphocytes (K/μl) [0.6-4.9], upon presentation | 0.8 | 1.1 | 0.9 | 0.9 | 0.2–2.4 | 0.9 | 0.2 | 0.2 | 0.5 | 0.4–1.1 |
| Lymphocytes, lowest value during hospitalization | 0.4 | 1.1 | 0.9 | 0.4 | 0.2–1.6 | 0.6 | 0.2 | 0.2 | 0.2 | 0.1–0.5 |
| Days of lymphopenia (total days below 1.0 K/μl) | 7 | 0 | 2 | 19 | 0–4 | 8 | 24 | 7 | 17 | 1–13 |
| T-cell counts | ||||||||||
| CD3+ (/μl) [510-2607], upon presentation | 636 | 1012 | 1373 | 1071 | 848–1205 | 592 | 414 | 106 | 273 | 729–1359 |
| CD3+CD4+ (/μl) [302-1779], upon presentation | 415 | 562 | 982 | 668 | 619–774 | 404 | 83 | 56 | 206 | 572–926 |
| CD3+CD8+ (/μl) [101-951], upon presentation | 168 | 401 | 336 | 380 | 199–289 | 176 | 311 | 44 | 59 | 55–343 |
| T-cell phenotype | ||||||||||
| CD4+CD38+HLA-DR+ % [0.30-1.35] | 5.0 | 11.3 | 1.3 | 6.7 | 2.7–4.8 | 4.5 | 13.9 | 5.8 | 16.3 | 3.3–17.8 |
| CD4+CD25+CD127- % [4.64-8.05] | 2.3 | 4.2 | 16.8 | 4.1 | 2.6–4.4 | 6.5 | 3.3 | 0.0 | 8.8 | 2.4–18.1 |
| CD4+ICOS+CXCR5+ % [0.64-2.72] | 1.7 | 3.3 | 1.2 | 1.4 | 0.3–1.6 | 0.1 | 2.6 | 1.3 | 3.8 | 0.6–2.5 |
| CD4+CD45RO+ % [9.9-37.7] | 38.3 | 37.7 | 41.7 | 55.7 | 39.0–50.0 | 35.0 | 18.2 | 15.7 | 68.3 | 15.3–48.1 |
| CD4+CD45RA+ % [3.4-37.9] | 16.7 | 11.5 | 14.5 | 2.3 | 3.5–14.5 | 19.1 | 2.7 | 21.8 | 1.5 | 7.5–48.1 |
| CD8+CD38+HLA-DR+ % [0.13-2.68] | 31.8 | 48.6 | 1.9 | 24.6 | 11.5–33.4 | 35.5 | 27.2 | 21.6 | 20.6 | 14.7–56.6 |
| CD8+CD45RO+ % [1.0-8.3] | 11.0 | 5.5 | 4.3 | 19.5 | 3.1–13.7 | 3.3 | 23.8 | 2.2 | 13.1 | 0.3–7.0 |
| CD8+CD45RA+ % [2.4-23.0] | 8.2 | 18.9 | 3.8 | 5.7 | 6.0–12.3 | 18.9 | 31.3 | 30.2 | 2.2 | 11.3–17.3 |
| Inflammasome activity | ||||||||||
| Caspase-1 CD45+CD3+ % [2.11-4.90] | 22.38 | 26.41 | 21.16 | 19.68 | 19.54–40.11 | 20.21 | 28.44 | 18.36 | 16.80 | 12.79–35.66 |
| Caspase-1 CD45+CD3+CD4+ % [1.87-3.67] | 17.61 | 24.93 | 21.22 | 21.54 | 11.57–38.37 | 15.63 | 30.83 | 16.77 | 17.38 | 11.10–31.11 |
| IL-18 (pg/ml) [60-275] | 400.0 | 989.6 | 304.5 | 439.2 | 1376–4496 | 229.4 | 162.2 | 469.2 | 162.6 | 610–2425 |
For the 8 MedStar Georgetown Transplant Institute liver patients, individual patient data are shown. For the 8 SUNY Downstate Medical Center (SUNY) non-liver control patients, summaries or ranges of high and low patient data are shown for the 4 non-lethal and 4 lethal cases, respectively. “Upon presentation” refers to the first data point available upon COVID-19 presentation; “during hospitalization” refers to data points collected during COVID-19 related hospitalization. Numbers in square brackets represent normal reference ranges from MedStar Georgetown Transplant Institute and CLIA-certified tests. Normal reference ranges for SUNY are listed in supplementary materials & methods. AIH, autoimmune hepatitis; ALF, acute liver failure; ALP, alkaline phosphatase; ALT, alanine aminotransferase; AST, aspartate aminotransferase; COVID-19, coronavirus disease 2019; CD, cluster of differentiation; CD4+CD25+CD127-, T-regulatory cell; CD4+ICOS+CXCR5+, T follicular helper cell; CLIA, Clinical Laboratory Improvement Amendments; CRP, C-reactive protein; ETOH, ethyl alcohol; HCV, hepatitis C virus; HLA, human leukocyte antigen; ICU, intensive care unit; IL, interleukin; LDH, lactate dehydrogenase; NAFLD, non-alcoholic fatty liver disease; O2, oxygen; PSC, primary sclerosing cholangitis; WBC, white blood cell count.