Viral and host factors related to the clinical outcome of COVID-19

Xiaonan Zhang, Yun Tan, Yun Ling, Gang Lu, Feng Liu, Zhigang Yi, Xiaofang Jia, Min Wu, Bisheng Shi, Shuibao Xu, Jun Chen, Wei Wang, Bing Chen, Lu Jiang, Shuting Yu, Jing Lu, Jinzeng Wang, Mingzhu Xu, Zhenghong Yuan, Qin Zhang, Xinxin Zhang, Guoping Zhao, Shengyue Wang (), Saijuan Chen () and Hongzhou Lu ()
Additional contact information
Xiaonan Zhang: Fudan University
Yun Tan: Ruijin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine
Yun Ling: Fudan University
Gang Lu: Ruijin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine
Feng Liu: Ruijin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine
Zhigang Yi: Fudan University
Xiaofang Jia: Fudan University
Min Wu: Fudan University
Bisheng Shi: Fudan University
Shuibao Xu: Fudan University
Jun Chen: Fudan University
Wei Wang: Fudan University
Bing Chen: Ruijin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine
Lu Jiang: Ruijin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine
Shuting Yu: Ruijin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine
Jing Lu: Ruijin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine
Jinzeng Wang: Ruijin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine
Mingzhu Xu: Fudan University
Zhenghong Yuan: Fudan University
Qin Zhang: Shanghai Jiao Tong University School of Medicine
Xinxin Zhang: Ruijin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine
Guoping Zhao: Chinese Academy of Sciences
Shengyue Wang: Ruijin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine
Saijuan Chen: Ruijin Hospital Affiliated to Shanghai Jiao Tong University (SJTU) School of Medicine
Hongzhou Lu: Fudan University

Nature, 2020, vol. 583, issue 7816, 437-440

Abstract: Abstract In December 2019, coronavirus disease 2019 (COVID-19), which is caused by the new coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in Wuhan (Hubei province, China)1; it soon spread across the world. In this ongoing pandemic, public health concerns and the urgent need for effective therapeutic measures require a deep understanding of the epidemiology, transmissibility and pathogenesis of COVID-19. Here we analysed clinical, molecular and immunological data from 326 patients with confirmed SARS-CoV-2 infection in Shanghai. The genomic sequences of SARS-CoV-2, assembled from 112 high-quality samples together with sequences in the Global Initiative on Sharing All Influenza Data (GISAID) dataset, showed a stable evolution and suggested that there were two major lineages with differential exposure history during the early phase of the outbreak in Wuhan. Nevertheless, they exhibited similar virulence and clinical outcomes. Lymphocytopenia, especially reduced CD4+ and CD8+ T cell counts upon hospital admission, was predictive of disease progression. High levels of interleukin (IL)-6 and IL-8 during treatment were observed in patients with severe or critical disease and correlated with decreased lymphocyte count. The determinants of disease severity seemed to stem mostly from host factors such as age and lymphocytopenia (and its associated cytokine storm), whereas viral genetic variation did not significantly affect outcomes.

Date: 2020
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DOI: 10.1038/s41586-020-2355-0

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