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. 2023 Sep:169:156246.
doi: 10.1016/j.cyto.2023.156246. Epub 2023 Jun 2.

An immune-protein score combining TRAIL, IP-10 and CRP for predicting severe COVID-19 disease

Niv Samuel Mastboim  1 , Alon Angel  1 , Oded Shaham  1 , Tahel Ilan Ber  1 , Roy Navon  1 , Einav Simon  1 , Michal Rosenberg  1 , Yael Israeli  1 , Mary Hainrichson  1 , Noa Avni  1 , Eran Reiner  1 , Paul Feigin  2 , Kfir Oved  3 , Boaz Tadmor  4 , Pierre Singer  5 , Ilya Kagan  5 , Shaul Lev  5 , Dror Diker  5 , Amir Jarjou'I  6 , Ramzi Kurd  6 , Eli Ben-Chetrit  6 , Guy Danziger  7 , Sina A Tegethoff  7 , Cihan Papan  7 , Sergey Motov  8 , Ma'anit Shapira  9 , Michal Stein  10 , Tanya M Gottlieb  11 , Eran Eden  1 , Adi Klein  9
Affiliations

An immune-protein score combining TRAIL, IP-10 and CRP for predicting severe COVID-19 disease

Niv Samuel Mastboim et al. Cytokine. 2023 Sep.

Abstract

COVID-19 patients are oftentimes over- or under-treated due to a deficit in predictive management tools. This study reports derivation of an algorithm that integrates the host levels of TRAIL, IP-10, and CRP into a single numeric score that is an early indicator of severe outcome for COVID-19 patients and can identify patients at-risk to deteriorate. 394 COVID-19 patients were eligible; 29% meeting a severe outcome (intensive care unit admission/non-invasive or invasive ventilation/death). The score's area under the receiver operating characteristic curve (AUC) was 0.86, superior to IL-6 (AUC 0.77; p = 0.033) and CRP (AUC 0.78; p < 0.001). Likelihood of severe outcome increased significantly (p < 0.001) with higher scores. The score differentiated severe patients who further deteriorated from those who improved (p = 0.004) and projected 14-day survival probabilities (p < 0.001). The score accurately predicted COVID-19 patients at-risk for severe outcome, and therefore has potential to facilitate timely care escalation and de-escalation and appropriate resource allocation.

Keywords: COVID-19 disease severity prediction; Emergency Department; Host-immune protein score; SARS-CoV-2.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: AK, BT, MSt and MSh have indicated that they have no potential conflicts of interest to disclose. AA, EE, ER, ES, KO, MH, MR, NA, NSM, OS, RN, TIB, TMG and YI are/were employees of MeMed and hold stock and/or options; PF holds MeMed stock options; SL declares to have received lecturing fees from MeMed; EE, ES, KO, MH, NSM, OS, RN, SL, TIB, TMG are inventors of pending or issued patent applications relating to the TRAIL/IP-10/CRP technology; AJ, EBC, IK, DD, SL, PS, RK, SM, SAT, GD and CP declare that their medical center received funding from MeMed.

Figures

Fig. 1
Fig. 1
Differential expression of TRAIL, IP-10, CRP (A) and score (B) in severe and non-severe COVID-19 infection. Dots represent patients and boxes denote median and IQR (interquartile range). TRAIL, tumor necrosis factor-related apoptosis inducing ligand. IP-10, interferon gamma inducible protein-10. CRP, C-reactive protein.
Fig. 2
Fig. 2
Receiver operating characteristic (ROC) curve of the score compared to known risk factors and candidate severity tools. In each of the plots, the ROC curve and area under the curve (AUC) were calculated for all patients that had the specific measurement available. CRP, C-reactive protein. IL-6, interleukin-6. PCT, procalcitonin.
Fig. 3
Fig. 3
Score in severe patients meeting severity outcome on or after the day of blood draw stratified by time to first severe outcome, in comparison to non-severe patients. Dots represent patients and boxes denote median and IQR (interquartile range).
See this image and copyright information in PMC

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