Associations of medications used during hospitalization and immunological changes in patients with COVID-19 during 3-month follow-up

Highlights • Study on the immunological changes in COVID-19 patients during 3-Month Follow-up; • Antibiotics use during hospital stay was related to a decrease in IgG after discharge; • Glucocorticoid intake was associated with an increase in CD4+T cell after discharge.
Background Understanding the immunological responses in COVID-19 patients during their recovery period is essential to the development of a vaccine and herd immunity. Methods This retrospective cohort study screened 233 patients admitted to the First Hospital of Changsha, China with COVID-19 from January 17th to February 29th, 2020. After completion of SARS-CoV2-specific immunoglobulins, and T cells tests at 2-week and 3-month follow-up points after discharge, 87 were enrolled. Wilcoxon signed-rank test was performed to assess changes in the values of IgG and IgM, the number of CD3+, CD4+ and CD8+ T cells, and CD4+/CD8+ ratio during the 3-month follow-up. Linear regressions were used to evaluate the associations of immunological changes and medications during hospitalization. Results The positive rate of IgG decreased from 98.6% (40/41) to 85.4% (35/41) in men and 100% (43/43) to 76.7% (33/43) in women, whereas IgM declined from 34.1% (14/41) to 12.2% (5/41) in men and 37.2% (16/43) to 27.9% (12/43) in women during the follow-up. CD4+ T cells increased from (median (IQR), 484 (384-635)) cells/ul to 543 (414-657) cells/ul (P=0.01). Antibiotic use was negatively associated with IgG change (mean change [95%CI], 8.08 [0.80 to 15.37] U, P=0.03), and glucocorticoid use was positively related to increased CD4+ T cells (100.85 [16.56 to 185.15] cells/ul, P=0.02). Conclusion This study demonstrated that the positive rates and values of IgG and IgM decreased in COVID-19 patients over a 3-month follow-up, while CD4+ T cells significantly increased. Moreover, we found that antibiotic use during hospitalization was associated with IgG decrease, and glucocorticoid use was associated with increases in CD4+ T cells.