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Basic Predictive Risk Factors for Cytokine Storms in COVID-19 Patients
Sergey G Shcherbak1,2, Anna Yu Anisenkova1,2, Sergei V Mosenko1,2
1City Hospital №40, Saint Petersburg, Russia.
Insights
Identifying cytokine storm risk in COVID-19 patients is crucial. This study developed a prognostic score using biomarkers like NEWS score, IL-6, and CRP to predict severe disease and guide early anti-inflammatory therapy.
Area of Science:
- Immunology
- Infectious Diseases
- Critical Care Medicine
Background:
- Immune dysregulation and cytokine storm (CS) are key in severe COVID-19 pathogenesis.
- Early identification of patients at risk for CS is vital for timely intervention.
- Existing prognostic tools may not fully capture the complexity of CS development in COVID-19.
Purpose of the Study:
- To identify prognostic biomarkers for cytokine storm (CS) development in coronavirus disease 2019 (COVID-19) patients.
- To integrate these biomarkers into a practical prognostic score for routine clinical use.
- To facilitate early detection and management of severe COVID-19 cases associated with CS.
Main Methods:
- Retrospective review of 458 COVID-19 patient records.
- Utilized clinical assessment, chest CT scans, ECG, and laboratory tests (ferritin, CRP, IL-6, LDH, D-dimer).
- Incorporated the National Early Warning Score (NEWS) and its dynamics.
Main Results:
- Key risk factors for CS include male gender, age >40, positive SARS-CoV-2 RNA, low lymphocyte count, NEWS score dynamics, LDH, D-dimer, ferritin, and IL-6.
- A prognostic scale incorporating NEWS score dynamics, IL-6, CRP, lymphocyte count, SARS-CoV-2 RNA status, and age was developed.
- This scale effectively identifies patients at high risk for cytokine storm.
Conclusions:
- The developed prognostic score is a valuable tool for identifying COVID-19 patients at high risk of cytokine storm.
- Early identification enables timely initiation of anti-inflammatory therapy.
- Biomarkers such as NEWS score dynamics, IL-6, and CRP levels are crucial for monitoring CS risk.
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 × 109/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.
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