Objective A critical role in coronavirus disease 2019 (COVID-19) pathogenesis is played by immune dysregulation that leads to a generalized uncontrolled multisystem inflammatory response, caused by overproduction of proinflammatory cytokines, known as “a cytokine storm” (CS), strongly associated with a severe course of disease. The aim of this study is to identify prognostic biomarkers for CS development in COVID-19 patients and integrate them into a prognostic score for CS-associated risk applicable to routine clinical practice. Materials and Methods The authors performed a review of 458 medical records from COVID-19 patients (241 men and 217 women aged 60.0 ± 10.0) who received treatment in the St. Petersburg State Budgetary Institution of Healthcare City Hospital 40 (City Hospital 40, St. Petersburg), from Apr. 18, 2020 to Nov. 21, 2020. The patients were split in two groups: one group included 100 patients with moderate disease symptoms; the other group included 358 patients with progressive moderately severe, severe, and extremely severe disease. The National Early Warning Score (NEWS) score was used alongside with clinical assessment, chest computed tomographic (CT) scans, electrocardiography (ECG), and lab tests, like ferritin, C-reactive protein (CRP), interleukin (IL)-6, lactate dehydrogenase (LDH), and D-dimer. Results The basic risk factors for cytokine storms in COVID-19 patients are male gender, age over 40 years, positive test result for replicative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA, absolute lymphocyte count, dynamics in the NEWS score, as well as LDH, D-dimer, ferritin, and IL-6 levels. These clinical and instrumental findings can be also used as laboratory biomarkers for diagnosis and dynamic monitoring of cytokine storms. The suggested prognostic scale (including the NEWS score dynamics; serum IL-6 greater than 23 pg/ml; serum CRP 50 mg/L or greater; absolute lymphocyte count less than 0.72 × 10 9 /L; positive test result for replicative coronavirus (SARS-CoV-2) RNA; age 40 years and over) is a useful tool to identify patients at a high risk for cytokine storm, requiring an early onset of anti-inflammatory therapy.
【저자키워드】 COVID-19, Cytokine storm, patients, clinical and biochemical prognostic factors, prognostic scale, 【초록키워드】 Treatment, coronavirus disease, Prognostic biomarkers, SARS-CoV-2, Coronavirus disease 2019, Cytokine storm, coronavirus, Cytokines, Pathogenesis, IL-6, Diagnosis, LDH, Gender, C-reactive protein, risk, CRP, D-dimer, ferritin, cytokine, risk factor, lactate dehydrogenase, ECG, RNA, lymphocyte, serum, interleukin, Chest, male, Patient, age, Electrocardiography, laboratory biomarkers, women, prognostic, respiratory, proinflammatory cytokines, disease, Critical, score, prognostic biomarker, COVID-19 patients, Absolute lymphocyte count, Lactate, Inflammatory response, severe disease, COVID-19 patient, Cytokine storms, immune dysregulation, high risk, IL-6 levels, leads, dysregulation, test result, medical records, medical record, clinical assessment, Anti-inflammatory therapy, Serum IL-6, acute respiratory syndrome, two groups, acute respiratory syndrome coronavirus, acute respiratory syndrome coronavirus 2, city, institution, serum CRP, material, positive test result, overproduction, routine clinical practice, men, lab, state, objective, Course, Result, greater, identify, performed, was used, caused, less, suggested, replicative, chest computed tomographic, laboratory biomarker, patients with moderate, 【제목키워드】 Factor, storm, basic,