Improved understanding and management of COVID-19, a potentially life-threatening disease, could greatly reduce the threat posed by its etiologic agent, SARS-CoV-2. Toward this end, we have identified a core peripheral blood immune signature across 63 hospital-treated patients with COVID-19 who were otherwise highly heterogeneous. The signature includes discrete changes in B and myelomonocytic cell composition, profoundly altered T cell phenotypes, selective cytokine/chemokine upregulation and SARS-CoV-2-specific antibodies. Some signature traits identify links with other settings of immunoprotection and immunopathology; others, including basophil and plasmacytoid dendritic cell depletion, correlate strongly with disease severity; while a third set of traits, including a triad of IP-10, interleukin-10 and interleukin-6, anticipate subsequent clinical progression. Hence, contingent upon independent validation in other COVID-19 cohorts, individual traits within this signature may collectively and individually guide treatment options; offer insights into COVID-19 pathogenesis; and aid early, risk-based patient stratification that is particularly beneficial in phasic diseases such as COVID-19.

提高对 COVID-19 这种潜在危及生命的疾病的了解和管理，可以大大减少其病原体 SARS-CoV-2 造成的威胁。为此，我们在 63 名住院治疗的 COVID-19 患者中确定了核心外周血免疫特征，这些患者在其他方面具有高度异质性。该特征包括 B 细胞和骨髓单核细胞组成的离散变化、T 细胞表型的深刻改变、选择性细胞因子/趋化因子上调和 SARS-CoV-2 特异性抗体。一些标志性特征确定了与免疫保护和免疫病理学的其他设置的联系；其他因素，包括嗜碱性粒细胞和浆细胞样树突细胞耗竭，与疾病严重程度密切相关；而第三组特征，包括 IP-10、白细胞介素 10 和白细胞介素 6 的三联体，可预测随后的临床进展。因此，根据其他 COVID-19 队列的独立验证，该特征中的个体特征可以共同或单独指导治疗选择；提供对 COVID-19 发病机制的见解；并帮助基于风险的早期患者分层，这对于 COVID-19 等阶段性疾病特别有益。