Resumen

DE SWARDT, C; DE VILLIERS, M  y  VAN ZYL, D G. The association between comorbid conditions and CD4+ T-cell counts with in-hospital mortality of patients with moderate to critical COVID-19 disease. SAMJ, S. Afr. med. j. [online]. 2025, vol.115, n.10, pp.29-34. ISSN 2078-5135.  https://doi.org/10.7196/SAMJ.2025.v115i10.2793.

BACKGROUND. COVID-19 presents with variable severity, and identifying accessible prognostic markers is critical in resource-limited settings such as South Africa (SA), where the prevalence of HIV may influence immune response and outcomes. OBJECTIVES. To assess the association between CD4+ T-cell count and in-hospital mortality among patients with moderate to severe COVID-19 infection in SA, with a focus on specific comorbid conditions. METHODS. This cross-sectional analytical study analysed data from the first COVID-19 wave, using an electronic database compiled during the first wave of the epidemic as well as clinical records. During this period, 336 patients with moderate to critical COVID-19 were admitted to Kalafong Provincial Tertiary Hospital in Pretoria, SA. The analysis included only those patients in whom CD4+ T-cell counts (n=270) were done. Mean CD4+ T-cell counts were compared between survivors and non-survivors using non-parametric statistics. Logistic regression was performed to adjust for confounders, with survival status as the outcome variable. RESULTS. Sixty-nine of the 270 patients (26%) died. Mortality rates by severity of COVID were moderate (7/49, 14.3%), severe (55/211, 26.1%) and critical (7/10, 70%) (p=0.001). Patients who were positive for HIV had significantly higher mortality (19/52, 36.5%) than HIV-negative patients (50/218, 22.9%) (p=0.0436). Non-survivors had significantly lower CD4+ T-cell counts (p<0.001). After adjusting for age, hypertension, diabetes, pre-diabetes, renal disease, critical COVID-19 disease and HIV status, the CD4+ T-cell count remained significantly lower in non-survivors (p<0.001). CONCLUSION. In patients with moderate to critical COVID-19 disease, lower CD4+ T-cell counts were significantly associated with mortality, suggesting that this may serve as a useful marker for predicting outcomes.

Palabras clave : COVID-19; CD4+ T-cell count; prognostic marker; HIV; comorbidities; mortality; resource-limited settings.

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