The immune checkpoints storm in COVID‐19: Role as severity markers at emergency department admission

[...]their relevance are still being discussed.1 Patients with severe COVID-19 show an impairment of the immune system allowing secondary infections,2–5 and numerous studies have found how T cell polyfunctionality decreases.5,6 In this regard, immune checkpoints (ICs), a family of molecules known for their ability to modulate immune response and induce T cell exhaustion and apoptosis, become interesting not only as potential early biomarkers of patients’ evolution but also as possible pharmaceutical targets.7 Thus, we recruited 69 patients and 15 healthy volunteers (HVs) from the emergency department (ED) of La Paz University Hospital. Levels of sCD25, sTim-3, Galectin-9 and sPD-L1, but not sCD86, showed a negative correlation with ALC (Supplemental Figures S11A and S12). [...]negative correlation between T cell proliferation and circulating levels of sCD25, sTim-3 and Galectin-9 was also observed (Supplemental Figure S11B-C). TABLE 1 Variables analysed as potential biomarkers for mortality Variable ROC Univariate logistic regression AUC p-value OR OR IC 95 p-value Age* 0.8019 .0005 1.0793 1.029183–1.131854 .0017 Sex (male) 0.6130 .1942 2.526 0.764313–8.35033 .1287 AHT* 0.7026 .0199 5.5800 1.533836–20.359662 .0091 DM 0.5786 .3667 2.2222 0.619494–7.971464 .2205 CVD 0.5604 .4878 1.7949 0.51024–6.313824 .3621 CKD 0.5974 .2631 4.0000 0.910787–17.567221 .0663 OBESITY 0.5552 .5260 0.3462 0.040472–2.960613 .3327 COPD 0.5883 .3103 3.2667 0.776781–13.73761 .1062 Onco 0.5006 .9940 0.9808 0.100886–9.534592 .9866 ImmunoD 0.5013 .9881 0.9792 0.183563–5.22311 .9803 Temperature 0.5812 .3510 1.1719 0.627006–2.190483 .6191 Heart rate 0.5396 .6490 1.0084 0.976758–1.041001 .6081 Resp rate* 0.7695 .0020 1.1780 1.048269–1.323747 .0059 SpO2* 0.7318 .0077 0.8853 0.797259–0.982972 .0225 FiO2 0.6506 .0835 1.2276 1.036604–1.453895 .0175 SpO2/FiO2* 0.8214 .0002 0.9802 0.968543–0.99202 .0011 Lactate* 0.8364 .0001 9.2471 2.633093–32.474967 .0005 Absolute leukocytes 0.5513 .5556 1.0000 0.999919–1.000092 .8960 ANC 0.5987 .2568 1.0002 0.999983–1.000375 .0733 ALC* 0.8234 .0002 0.9969 0.994924–0.99884 .0018 AMC 0.6110 .2020 0.9983 0.99464–1.001913 .3514 N/L ratio* 0.7974 .0006 1.0658 1.005046–1.13017 .0333 Platelets* 0.7383 .0062 0.9999 0.999985–0.999998 .0095 Ferritin 0.7403 .0058 1.0005 0.999808–1.001173 .1588 D-Dimer* 0.7435 .0051 1.0004 1.000033–1.000805 .0332 Creatinine 0.7221 .0107 1.1703 0.793126–1.726702 .4283 AST 0.5117 .8932 1.0037 0.997514–1.009897 .2423 ALT 0.5416 .6330 0.9924