ABSTRACT
The COVID-19 pandemic continues to challenge the capacities of hospital ICUs which currently lack the ability to identify prospectively those patients who may require extended management. In this study of 90 ICU COVID-19 patients, we used multiplexed cytokine evaluation and, on 42 of these patients (binned into Initial and Replication Cohorts), CyTOF-based deep immunophenotyping. This revealed blood prognostic biomarkers that, at time of ICU admission, prospectively distinguish, with 91% sensitivity and 91% specificity, patients who will subsequently die or have long ICU stays (> 6 days) from those who will have short-stays (< 6 days). This is achieved through a tiered evaluation of serum IL-10 and targeted immunophenotyping of monocyte subsets (specifically, CD11clow classical monocytes) through statistical approaches. We have distilled this down to a prognostic test that could prove useful in guiding clinical resource allocation, treatment regimens and assessment of new therapeutic interventions.