{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:27:23Z","timestamp":1786976843811,"version":"build-2736575974"},"reference-count":17,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,3,21]],"date-time":"2025-03-21T00:00:00Z","timestamp":1742515200000},"content-version":"vor","delay-in-days":79,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acute Medicine &amp; Surgery"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Lymphopenia is recognized as a biomarker for predicting outcomes in coronavirus disease (COVID\u201019). However, the optimal timing for its observation remains uncertain. We investigated the association between early lymphopenia and COVID\u201019 prognosis, as well as the relationship between lymphocyte count trends and disease outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed data from the J\u2010RECOVER study, a multicenter retrospective cohort study in Japan, encompassing patients with COVID\u201019 between January and September 2020. The patients were categorized into lymphopenia (LP) (&lt;800 cells\/\u03bcL) and non\u2010lymphopenia (NL) (\u2265800 cells\/\u03bcL) groups based on the lymphocyte counts between days 1 and 4 post\u2010onset. They were further divided into \u201cpersistent,\u201d \u201crecovered,\u201d \u201cexacerbated,\u201d and \u201cstable\u201d groups based on lymphocyte counts between days 7 and 10. The primary outcome was the in\u2010hospital mortality. The Cox proportional hazard regression was used for the analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 995 enrolled patients, 212 patients (21.3%) were classified into the LP group. LP was significantly associated with in\u2010hospital mortality (hazard ratio [HR] 2.32, [95% CI 1.39 to 3.87],\n                      <jats:italic>p<\/jats:italic>\n                      \u2010value 0.001). In both the LP and NL groups, lower lymphocyte counts between 7 and 10\u2009days\u2014categorized as the \u201cpersistent\u201d and \u201cexacerbated\u201d groups\u2014was associated with in\u2010hospital mortality (HR 4.65, [95% CI 2.07 to 10.47],\n                      <jats:italic>p<\/jats:italic>\n                      \u2010value &lt;0.001, and HR 5.59, [95% CI 2.24 to 13.97],\n                      <jats:italic>p<\/jats:italic>\n                      \u2010value &lt;0.001, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Early lymphopenia is predictive of poor prognosis in patients with COVID\u201019. A declining lymphocyte count trend post\u2010onset further indicates disease deterioration.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ams2.70044","type":"journal-article","created":{"date-parts":[[2025,3,23]],"date-time":"2025-03-23T10:49:47Z","timestamp":1742726987000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Early lymphopenia as a predictor of COVID\u201019 outcomes: A multicenter cohort study"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1825-1759","authenticated-orcid":false,"given":"Kazuhiro","family":"Okada","sequence":"first","affiliation":[{"name":"Shock and Trauma Center Nippon Medical School Chiba Hokusoh Hospital  Chiba Japan"},{"name":"Department of Emergency and Critical Care Medicine Nippon Medical School  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6953-1932","authenticated-orcid":false,"given":"Takashi","family":"Tagami","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine Nippon Medical School  Tokyo Japan"},{"name":"Department of Emergency and Critical Care Medicine Nippon Medical School Musashikosugi Hospital  Kawasaki Kanagawa Japan"},{"name":"Department of Clinical Epidemiology and Health Economics, School of Public Health The University of Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takanobu","family":"Otaguro","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine Nagasaki University Hospital  Nagasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8341-7626","authenticated-orcid":false,"given":"Mineji","family":"Hayakawa","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Hokkaido University Hospital  Sapporo Hokkaido Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2999-4021","authenticated-orcid":false,"given":"Kazuma","family":"Yamakawa","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine Osaka Medical and Pharmaceutical University  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Endo","sequence":"additional","affiliation":[{"name":"Department of Acute Critical Care Medicine Tsuchiura Kyodo General Hospital  Ibaraki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayuki","family":"Ogura","sequence":"additional","affiliation":[{"name":"Tochigi Prefectural Emergency and Critical Care Center, Imperial Gift Foundation Saiseikai Utsunomiya Hospital  Tochigi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Hirayama","sequence":"additional","affiliation":[{"name":"Public Health, Department of Social Medicine, Graduate School of Medicine Osaka University  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideo","family":"Yasunaga","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Health Economics, School of Public Health The University of Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiaki","family":"Hara","sequence":"additional","affiliation":[{"name":"Shock and Trauma Center Nippon Medical School Chiba Hokusoh Hospital  Chiba Japan"},{"name":"Department of Emergency and Critical Care Medicine Nippon Medical School  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,21]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"World Health Organization.WHO Coronavirus (COVID\u201019) dashboard.2023[updated 2024 Aug 24]. Available from:https:\/\/covid19.who.int."},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30183-5"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.1585"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjebm-2020-111536"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30566-3"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.37737\/ace.22012"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40560-020-00453-4"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp2009249"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/all.14364"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/cbin.11403"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2020.03.012"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/cyto.a.24172"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/jmcb\/mjac021"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/jmcb\/mjac034"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12964-024-01718-3"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000026503"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41392-020-0148-4"}],"container-title":["Acute Medicine &amp; Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ams2.70044","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T07:46:18Z","timestamp":1766475978000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ams2.70044"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":17,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1002\/ams2.70044"],"URL":"https:\/\/doi.org\/10.1002\/ams2.70044","archive":["Portico"],"relation":{},"ISSN":["2052-8817","2052-8817"],"issn-type":[{"value":"2052-8817","type":"print"},{"value":"2052-8817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]},"assertion":[{"value":"2024-09-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70044"}}