Prognosis of immune state following basic therapy and thymalin treatment in patients with severe COVID-19 infection

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Abstract

Significant changes in cellular and humoral immunity are observed in new coronavirus infection (COVID-19). The “cytokine storm” develops in cases of severe clinical course, being accompanied by significantly increased levels of pro-inflammatory cytokines, often associated with suppression of immune response. At the same time, the prediction of the immune status is an urgent task, thus allowing timely correction of current therapy. The aim of our research was to evaluate predictive capability for the immune system changes on the 6th day of COVID-19 disease when using standard therapy, or with addition of immunocorrector thymalin to the treatment regimen. A retrospective study was conducted in 87 patients with severe COVID-19. All patients were divided into 2 groups, i.e., (1) controls who received basic treatment; (2) basic treatment supplied with thymalin (10 mg, intramuscular injections daily for 5 days). Assessment of severity and clinical course of COVID-19, and basic treatment regimen for the patients corresponded to current version of the interim Guidelines from the Ministry of Health of the Russian Federation “Prevention, diagnosis and treatment of a new coronavirus infection COVID-19”. Laboratory studies included complete blood counts, immunogram parameters with the calculation of the ratio of certain types of leukocytes were performed on the 1st and 6th days of observation. Statistical evaluation was made using scripts of the specialized statistical analysis language R (http://cran.r-project.org) version 4.1.3. The blood parameters were evaluated using the binary classification method. The changes in parameters of cellular immunity were classified by means of ROC-analysis.

We have found that the basic therapy of severely ill COVID-19 patients was not followed by recovery of immune status on the 6th day from the start of treatment. At marginal level, one can only suggest a probable prediction of increase in WBC and MON counts, a decrease in CD4+, NK and CD8+perNK, as well as the CD4+/CD8+ ratio. Addition of thymalin to the basic therapy is largely accompanied by the normalization of immunogram parameters. At the same time, it is possible to predict, with “excellent” rating, an increased number of T-LIM, including CD4+ and B-LIM, and, with “good” rating, an increase in the total numbers of LIM, as well as CD8+, HLA-CD3+DR+ and NK cells. The data obtained in severe cases of COVID-19 make it possible to predict changes in immune status, and, hence, the course of the disease, at a high degree of probability.

About the authors

Boris I. Kuznik

Chita State Medical Academy; Innovation Сlinic “Health Academy”

Email: bi_kuznik@mail.ru
ORCID iD: 0000-0002-2502-9411

PhD, MD (Medicine), Professor, Department of Normal Physiology, Chita State Medical Academy; Innovation Clinic "Health Academy"

Russian Federation, Chita; Chita

Yurii N. Smolyakov

Chita State Medical Academy; Innovation Сlinic “Health Academy”

Email: smolyakov@rambler.ru
ORCID iD: 0000-0001-7920-7642

PhD (Medicine), Associate Professor, Head, Department of Medical Physic and Informatics, Chita State Medical Academy, Innovation Clinic "Health Academy"

Russian Federation, Chita; Chita

Konstantin G. Shapovalov

Chita State Medical Academy; State Clinical Hospital No. 1, Chita

Email: shkg26@mail.ru
ORCID iD: 0000-0002-3485-5176

PhD, MD (Medicine), Professor, Head, Department of Anestesiology, Reanimation and Intensive Therapy, Chita State Medical Academy; State Clinical Hospital No. 1

Russian Federation, Chita; Chita

Pavel P. Tereshkov

Chita State Medical Academy

Email: tpp6915@mail.ru
ORCID iD: 0000-0002-8601-3499

PhD (Medicine), Head, Laboratory of Experimental and Clinical Biochemestry and Immunology, Chita State Medical Academy

Russian Federation, Chita

Valerii A. Konnov

Chita State Medical Academy

Email: vlrknv@mail.ru
ORCID iD: 0000-0003-3540-178X

PhD (Medicine), Associate Professor, Department of Anestesiology, Reanimation and Intensive Therapy, Chita State Medical Academy

Russian Federation, Chita

Natalia I. Chalisova

St. Petersburg Institute of Bioregulation and Gerontology; Pavlov Institute of Physiology, Russian Academy of Sciences

Author for correspondence.
Email: ni-chalisova@mail.ru
ORCID iD: 0000-0002-2371-0043

PhD, MD (Biology), Professor, Leading Research Associate, Pavlov Institute of Physiology, Russian Academy of Sciences; Leading Research Associate, Laboratory of Oncogerontology of Biogerontology Department, St. Petersburg Institute of Bioregulation and Gerontology

Russian Federation, St. Petersburg; St. Petersburg

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2. Figure 1. ROC curves used for evaluation of changes in leukocyte pool when using conventional therapeutic schedule

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3. Figure 2. ROC curves used for evaluation of changes in T cells when using conventional therapeutic schedule

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4. Figure 3. ROC curves used for evaluation of the cell ratios when using conventional therapeutic schedule

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5. Figure 4. ROC curves used for evaluation of changes in leukocyte pool when using thymalin therapy

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6. Figure 5. ROC curves used for evaluation of changes in T cell pool when using thymalin therapy

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7. Figure 6. ROC curves used for evaluation of cell ratios when using thymalin therapy

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Copyright (c) 2022 Kuznik B.I., Smolyakov Y.N., Shapovalov K.G., Tereshkov P.P., Konnov V.A., Chalisova N.I.

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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