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. 2020 Dec:101:342-345.
doi: 10.1016/j.ijid.2020.10.003. Epub 2020 Oct 9.

A score combining early detection of cytokines accurately predicts COVID-19 severity and intensive care unit transfer

Carole Nagant  1 , Fanny Ponthieux  2 , Julie Smet  2 , Nicolas Dauby  3 , Virginie Doyen  4 , Tatiana Besse-Hammer  5 , David De Bels  6 , Evelyne Maillart  7 , Francis Corazza  8
Affiliations

A score combining early detection of cytokines accurately predicts COVID-19 severity and intensive care unit transfer

Carole Nagant et al. Int J Infect Dis. 2020 Dec.

Abstract

Objectives: We aimed to explore cytokine profile in patients as it relates to Coronavirus Disease 2019 (COVID-19) severity, and to establish a predictive cytokine score to discriminate severe from non-severe cases and provide a prognosis parameter for patients that will require intensive care unit (ICU) transfer.

Methods: Serum samples of 63 patients diagnosed with SARS-CoV-2 infection were collected early after hospital admission (day 0-3). Patients were categorized in five groups based on the clinical presentation, the PaO2/FiO2 ratio and the requirement of mechanical ventilation.

Results: Three cytokines, IL-6, IL-8 and IL-10, were markedly higher in severe forms (n = 44) than in non-severe forms (n = 19) (p < 0.005). A score combining levels of these three cytokines (IL-6*IL-8*IL-10) had the highest performance to predict severity: sensitivity of 86.4% (95% CI, 72.4-94.8) and specificity of 94.7% (95% CI, 74.0-99.9) for a cutoff value of 2068 pg/mL. Elevated levels of IL-6, IL-8 and IL-10 were also found in critically ill patients. The combination of IL-6*IL-10 serum levels allowed the highest predictability for ICU transfer: AUC of 0.898 (p < 0.0001).

Conclusion: The combinatorial IL-6*IL-8*IL-10 score at presentation was highly predictive of the progression to a severe form of the disease, and could contribute to improve patient triage and to adapt therapeutic strategy within clinical trials more accurately and efficiently.

Keywords: COVID-19; Disease severity; IL-6; Inflammatory cytokines; Intensive care unit; Prediction.

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Figures

Figure 1
Figure 1
Predictive power of early cytokine measurement. ROC curves of cytokines, CRP and fibrinogen levels to diagnose (A) non-severe versus severe and (B) critical versus non-critical patients with COVID-19. Kaplan-Meier analyses of ICU transfer in patients with (C) low (n = 50) versus high IL-6 levels (n = 13), (D) low (n = 46) versus high IL-10 levels (n = 17) and (E) low (n = 44) versus high IL-6*IL-10 score (n = 19).
See this image and copyright information in PMC

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