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Clin Immunol ; 221: 108614, 2020 12.
Article in English | MEDLINE | ID: covidwho-912100


The heterogeneous disease course of COVID-19 is unpredictable, ranging from mild self-limiting symptoms to cytokine storms, acute respiratory distress syndrome (ARDS), multi-organ failure and death. Identification of high-risk cases will enable appropriate intervention and escalation. This study investigates the routine laboratory tests and cytokines implicated in COVID-19 for their potential application as biomarkers of disease severity, respiratory failure and need of higher-level care. From analysis of 203 samples, CRP, IL-6, IL-10 and LDH were most strongly correlated with the WHO ordinal scale of illness severity, the fraction of inspired oxygen delivery, radiological evidence of ARDS and level of respiratory support (p ≤ 0.001). IL-6 levels of ≥3.27 pg/ml provide a sensitivity of 0.87 and specificity of 0.64 for a requirement of ventilation, and a CRP of ≥37 mg/l of 0.91 and 0.66. Reliable stratification of high-risk cases has significant implications on patient triage, resource management and potentially the initiation of novel therapies in severe patients.

C-Reactive Protein/metabolism , COVID-19/diagnosis , Cytokine Release Syndrome/diagnosis , Interleukin-6/blood , Respiratory Distress Syndrome/diagnosis , SARS-CoV-2/pathogenicity , Adult , Aged , Aged, 80 and over , Biomarkers/blood , COVID-19/blood , COVID-19/therapy , COVID-19/virology , Cytokine Release Syndrome/blood , Cytokine Release Syndrome/therapy , Cytokine Release Syndrome/virology , Female , Hospitalization , Humans , Interleukin-10/blood , L-Lactate Dehydrogenase/blood , Male , Middle Aged , Respiration, Artificial , Respiratory Distress Syndrome/blood , Respiratory Distress Syndrome/therapy , Respiratory Distress Syndrome/virology , Risk Factors , Severity of Illness Index