key: cord-0902869-v60vfo04
authors: Michael Henry, Brandon; Helena Santos de Oliveira, Maria; Cheruiyot, Isaac; Benoit, Stefanie W; Benoit, Justin L; Lippi, Giuseppe
title: Combined Cytokine Scores Assessed at Emergency Department Presentation Predicts COVID-19 Critical Illness
date: 2021-09-02
journal: Acta Biomed
DOI: 10.23750/abm.v92i4.11182
sha: 56d6ca874331f7c747b1b771036c434bff847d16
doc_id: 902869
cord_uid: v60vfo04

N/A.

To the Editor, Predicting progression to severe coronavirus disease 2019 (COVID-19) is essential for improving allocation of limited healthcare resources and optimizing triage in the emergency department (1) . A recent report by Nagant et al. (2) , combined cytokine measurements early in hospitalization (0-3 days) for accurate prediction of COVID-19 severity. Owing to observed differences in biomarkers between cohorts and geographical regions (3), as well as heterogeneity in timing of laboratory measurements in the context of the fluctuating course of SARS-CoV-2 infection, we aimed to apply the same cytokine scores for predicting disease course in the Cincinnati COVID-19 Emergency Department (ED) Cohort.

We enrolled adults from the ED with a molecular diagnosis of COVID-19. Blood was drawn during a routine collection under an institutional review board approved waiver of informed consent. Levels of interleukin (IL)-6, 8 and 10 were measured with a Meso Scale Discovery U-Plex assay (Rockville, Maryland, USA). The primary outcome was need for intensive care unit (ICU) admission, whilst need for hospitalization within 30 days of index ED visit and for renal replacement therapy (RRT) were secondary outcomes. The final study cohort consisted of 50 patients (60% males; median age, 50.5 years, interquartile range, 40.5-66.0 years), 32 (64%) requiring hospitalization within 30 days of ED visit, 14 (28%) requiring ICU admission, and 8 (16%) requiring RRT. The results are shown in Figure 1 . Both IL-6*IL-10 and IL-6*IL-8*IL-10 scores displayed similar predictive performance across the outcomes. IL-6*IL-10 displayed the most optimal performance for predicting the primary outcome (ICU admission) with an AUC of 0.89 (95%CI: 0.78 -0.99).

We hyperinflammatory response, as well as those who with predominant hypoinflammatory response, both conditions which significantly contribute to development of severe disease (4, 5) . Notably, we found different cut-offs for our combined cytokine scores compared to those reported by Nagant et al., which may be attributed to pre-analytical and analytical confounders, or differences in sampling day (at ED admission vs. within 0-3 days of hospitalization). Assessment of appropriate cut-offs will hence be required prior to clinical implementation. While these results should be confirmed in larger cohorts, using combined cytokine scores may be useful in risk stratifying COVID-19 patients at ED presentation.

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