Prognostic Utility of the Dublin-Boston Score for Short-Term Clinical Outcomes in Moderate-to-Severe COVID-19: A...

Background Amid the coronavirus disease 2019 (COVID-19) pandemic, the rapid increase in positive cases strained healthcare capacity, leading to shortages of ICU beds and ventilators. As the disease process was new, physicians faced significant challenges in clinical decision-making, such as determining when to escalate care, consider mechanical ventilation, and other management therapies. Interleukin-6 (IL-6) is the major proinflammatory cytokine that is responsible for "cytokine storm," and interleukin-10 (IL-10) is an anti-inflammatory cytokine. The Dublin-Boston score (DBS) was introduced to track the trend of these interleukin levels, which helps predict the prognosis of patients with moderate to severe illnesses and guides clinical decision-making. Objective To predict the clinical outcome in moderate to severe COVID-19 patients based on the ratio of IL-6 to IL-10 by using the DBS. Methodology This is a prospective cohort study done in 39 moderate-to-severely ill adult COVID-19 patients confirmed by reverse transcriptase polymerase chain reaction (RT-PCR). The longitudinal changes in cytokines, IL-6, IL-10, and the IL-6:IL-10 ratio on day one and day four of admission were measured. Clinical outcome is assessed by using the WHO-Clinical Progression Scale (WHO-CPS). Results are capped between -2 to +2. The relationship between the IL-6:IL-10 ratio and clinical outcome is assessed by using the formula: DBS = Δ(IL-6: IL-10) × 2. Analyses were conducted in IBM SPSS Statistics for Windows, Version 24 (Released 2016; IBM Corp., Armonk, New York, United States); two-sided tests with significance set at p<0.01. Associations between the DBS and WHO-CPS were examined. Results Among 39 patients with moderate-to-severe COVID-19 (24 declined by day four), the change in IL-6:IL-10 captured by the DBS strongly predicted short-term outcome. In a DBS-only logistic model, each one-point increase in DBS was associated with higher odds of decline (OR = 8.00), with excellent discrimination (AUC = 1.000) and low error (Brier = 0.019). Calibration indicated systematic over-prediction (intercept = 0.516; slope = 0.132). DBS outperformed single-analyte IL-6 (AUC: day four = 0.785; day one = 0.314). An adjusted model (DBS + age + sex) retained a large effect (OR = 8.57). WHO-CPS categories showed no significant distributional differences across DBS outcomes (χ² = 4.26, p = 0.119), but combining WHO-CPS with DBS preserved excellent discrimination with a similar calibration pattern. Conclusions In hospitalized patients with moderate-severe COVID-19, the DBS may be predictive of short-term clinical deterioration and may provide incremental prognostic information beyond IL-6 alone; confirmation in larger cohorts is warranted.