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Inflammatory phenotyping predicts clinical outcome in COVID-19.
Burke, H; Freeman, A; Cellura, D C; Stuart, B L; Brendish, N J; Poole, S; Borca, F; Phan, H T T; Sheard, N; Williams, S; Spalluto, C M; Staples, K J; Clark, T W; Wilkinson, T M A.
  • Burke H; School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, LF13A, South Academic Block, Southampton, SO16 6YD, UK. H.Burke@soton.ac.uk.
  • Freeman A; University Hospitals Southampton NHS Foundation Trust, Southampton, UK. H.Burke@soton.ac.uk.
  • Cellura DC; School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, LF13A, South Academic Block, Southampton, SO16 6YD, UK.
  • Stuart BL; University Hospitals Southampton NHS Foundation Trust, Southampton, UK.
  • Brendish NJ; School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, LF13A, South Academic Block, Southampton, SO16 6YD, UK.
  • Poole S; Southampton Clinical Trials Unit, University of Southampton, Southampton, UK.
  • Borca F; School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, LF13A, South Academic Block, Southampton, SO16 6YD, UK.
  • Phan HTT; University Hospitals Southampton NHS Foundation Trust, Southampton, UK.
  • Sheard N; School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, LF13A, South Academic Block, Southampton, SO16 6YD, UK.
  • Williams S; University Hospitals Southampton NHS Foundation Trust, Southampton, UK.
  • Spalluto CM; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
  • Staples KJ; University Hospitals Southampton NHS Foundation Trust, Southampton, UK.
  • Clark TW; Clinical Informatics Research Unit Faculty of Medicine, University of Southampton, Southampton, UK.
  • Wilkinson TMA; Southampton Clinical Trials Unit, University of Southampton, Southampton, UK.
Respir Res ; 21(1): 245, 2020 Sep 22.
Article in English | MEDLINE | ID: covidwho-781468
ABSTRACT

BACKGROUND:

The COVID-19 pandemic has led to more than 760,000 deaths worldwide (correct as of 16th August 2020). Studies suggest a hyperinflammatory response is a major cause of disease severity and death. Identitfying COVID-19 patients with hyperinflammation may identify subgroups who could benefit from targeted immunomodulatory treatments. Analysis of cytokine levels at the point of diagnosis of SARS-CoV-2 infection can identify patients at risk of deterioration.

METHODS:

We used a multiplex cytokine assay to measure serum IL-6, IL-8, TNF, IL-1ß, GM-CSF, IL-10, IL-33 and IFN-γ in 100 hospitalised patients with confirmed COVID-19 at admission to University Hospital Southampton (UK). Demographic, clinical and outcome data were collected for analysis.

RESULTS:

Age > 70 years was the strongest predictor of death (OR 28, 95% CI 5.94, 139.45). IL-6, IL-8, TNF, IL-1ß and IL-33 were significantly associated with adverse outcome. Clinical parameters were predictive of poor outcome (AUROC 0.71), addition of a combined cytokine panel significantly improved the predictability (AUROC 0.85). In those ≤70 years, IL-33 and TNF were predictive of poor outcome (AUROC 0.83 and 0.84), addition of a combined cytokine panel demonstrated greater predictability of poor outcome than clinical parameters alone (AUROC 0.92 vs 0.77).

CONCLUSIONS:

A combined cytokine panel improves the accuracy of the predictive value for adverse outcome beyond standard clinical data alone. Identification of specific cytokines may help to stratify patients towards trials of specific immunomodulatory treatments to improve outcomes in COVID-19.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Cytokines / Hospital Mortality / Coronavirus Infections / Inflammation Mediators / Pandemics Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Limits: Female / Humans / Male Country/Region as subject: Europa Language: English Journal: Respir Res Year: 2020 Document Type: Article Affiliation country: S12931-020-01511-z

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Cytokines / Hospital Mortality / Coronavirus Infections / Inflammation Mediators / Pandemics Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Limits: Female / Humans / Male Country/Region as subject: Europa Language: English Journal: Respir Res Year: 2020 Document Type: Article Affiliation country: S12931-020-01511-z