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.
【저자키워드】 COVID-19, IL-6, disease severity, intensive care unit, prediction, Inflammatory cytokines, 【초록키워드】 coronavirus disease, Coronavirus disease 2019, clinical trial, Cytokines, intensive care, Prognosis, mechanical ventilation, IL-6, SARS-COV-2 infection, severity, disease severity, intensive care unit, clinical trials, prediction, cytokine, progression, ICU, sensitivity, specificity, Critically ill, Patient, IL-8, Hospital admission, Inflammatory cytokines, IL-10, Care, predict, therapeutic strategy, critically ill patients, cytokine profile, Combination, AUC, Predictive, PaO2, 95% CI, serum samples, Serum level, serum levels, patient triage, PaO2/FiO2 ratio, transfer, five groups, cutoff value, non-severe cases, serum sample, parameter, Non-severe case, IMPROVE, highest, collected, diagnosed, the disease, form, contribute, five group, 【제목키워드】 intensive care, COVID-19 severity, predict, transfer,