LOX-1 + immature neutrophils predict severe COVID-19 patients at risk of thrombotic complications
Abstract
Rational
Lymphopenia and neutrophil/lymphocyte ratio may have prognostic value in coronavirus disease 2019 (COVID-19) severity.
Objective
We sought to investigate the representation of neutrophil subsets in severe and critical COVID-19 patients based on Intensive Care Units (ICU) and non-ICU admission.
Methods
We developed a multi-parametric neutrophil profiling strategy based on known neutrophil markers to distinguish COVID-19 phenotypes in critical and severe patients.
Results
Our results showed that 80% of ICU patients develop strong myelemia with CD10 − CD64 + immature neutrophils. Cellular profiling revealed two distinct neutrophil subsets expressing either the lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) or the Interleukin-3 receptor alpha (CD123), both significantly overrepresented in ICU patients compared to non-ICU patients. The proportion of LOX-1-expressing immature neutrophils positively correlated with clinical severity, with the cytokine storm (IL-1 β , IL-6, IL-8, TNF α ), and with intravascular coagulation. Importantly, high proportions of LOX-1 + -immature neutrophils are associated with high risks of severe thrombosis.
Conclusions
Together these data suggest that point of care enumeration of LOX-1-immature neutrophils might help distinguish patients at risk of thrombosis complication and most likely to benefit from intensified anticoagulant therapy.
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