[HTML][HTML] An inflammatory cytokine signature predicts COVID-19 severity and survival

DM Del Valle, S Kim-Schulze, HH Huang… - Nature medicine, 2020 - nature.com
DM Del Valle, S Kim-Schulze, HH Huang, ND Beckmann, S Nirenberg, B Wang, Y Lavin
Nature medicine, 2020nature.com
Several studies have revealed that the hyper-inflammatory response induced by severe
acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a major cause of disease
severity and death. However, predictive biomarkers of pathogenic inflammation to help
guide targetable immune pathways are critically lacking. We implemented a rapid multiplex
cytokine assay to measure serum interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-α and
IL-1β in hospitalized patients with coronavirus disease 2019 (COVID-19) upon admission to …
Abstract
Several studies have revealed that the hyper-inflammatory response induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a major cause of disease severity and death. However, predictive biomarkers of pathogenic inflammation to help guide targetable immune pathways are critically lacking. We implemented a rapid multiplex cytokine assay to measure serum interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-α and IL-1β in hospitalized patients with coronavirus disease 2019 (COVID-19) upon admission to the Mount Sinai Health System in New York. Patients (n = 1,484) were followed up to 41 d after admission (median, 8 d), and clinical information, laboratory test results and patient outcomes were collected. We found that high serum IL-6, IL-8 and TNF-α levels at the time of hospitalization were strong and independent predictors of patient survival (P < 0.0001, P = 0.0205 and P = 0.0140, respectively). Notably, when adjusting for disease severity, common laboratory inflammation markers, hypoxia and other vitals, demographics, and a range of comorbidities, IL-6 and TNF-α serum levels remained independent and significant predictors of disease severity and death. These findings were validated in a second cohort of patients (n = 231). We propose that serum IL-6 and TNF-α levels should be considered in the management and treatment of patients with COVID-19 to stratify prospective clinical trials, guide resource allocation and inform therapeutic options.
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