@article{b79b3973c334410fa0c357a90f72e601,
title = "Viral and host factors related to the clinical outcome of COVID-19",
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.",
keywords = "Adolescent, Adult, Aged, Aged, 80 and over, Aging, Animals, Asymptomatic Infections/epidemiology, Betacoronavirus/classification, COVID-19, China/epidemiology, Cohort Studies, Coronavirus Infections/complications, Critical Illness/epidemiology, Disease Progression, Evolution, Molecular, Female, Genetic Variation, Genome, Viral/genetics, Hospitalization/statistics & numerical data, Host-Pathogen Interactions/immunology, Humans, Inflammation Mediators/immunology, Interleukin-6/blood, Interleukin-8/blood, Lymphocyte Count, Lymphopenia/complications, Male, Middle Aged, Pandemics, Phylogeny, Pneumonia, Viral/complications, Respiratory Distress Syndrome/complications, SARS-CoV-2, T-Lymphocytes/cytology, Time Factors, Treatment Outcome, Virulence/genetics, Virus Shedding, Young Adult, Zoonoses/transmission",
author = "Xiaonan Zhang and Yun Tan and Yun Ling and Gang Lu and Feng Liu and Zhigang Yi and Xiaofang Jia and Min Wu and Bisheng Shi and Shuibao Xu and Jun Chen and Wei Wang and Bing Chen and Lu Jiang and Shuting Yu and Jing Lu and Jinzeng Wang and Mingzhu Xu and Zhenghong Yuan and Qin Zhang and Xinxin Zhang and Guoping Zhao and Shengyue Wang and Saijuan Chen and Hongzhou Lu",
note = "Funding Information: Acknowledgements This work was supported by National Megaprojects of China for Infectious Diseases (2017ZX10103009-001, 2018ZX10305409-001-005); Double First-Class Project of Fudan University (no. IDF162005); Scientific Research for Special Subjects on 2019 Novel Coronavirus of Shanghai Public Health Clinical Center (no. 2020YJKY01); Double First-Class Project (WF510162602) from the Ministry of Education, State Key Laboratory of Medical Genomics; Overseas Expertise Introduction Project for Discipline Innovation (111 Project, B17029); National Key R&D Program of China (2019YFA0905902); and the Shanghai Guangci Translational Medical Research Development Foundation. We acknowledge all healthcare personnel involved in the diagnosis and treatment of patients in Shanghai Public Health Clinical Center and we thank Z. Chen for guidance regarding study design, interpretation of results and critical revision of the manuscript. We also thank all researchers who shared SARS-CoV-2 genome sequences in GISAID. We thank the late Y. Hu of Shanghai Public Health Clinical Center for her lifelong commitment to infectious disease research. Publisher Copyright: {\textcopyright} 2020, The Author(s), under exclusive licence to Springer Nature Limited.",
year = "2020",
month = jul,
doi = "10.1038/s41586-020-2355-0",
language = "English",
volume = "583",
pages = "437--440",
journal = "Nature",
issn = "1476-4687",
publisher = "Nature Publishing Group",
number = "7816",
}