Scientists have developed a blood test and new scoring system that may help doctors predict which COVID-19 patients are at risk for severe disease and therefore in need of more intervention, according to a new study published in the journal EBioMedicine.
In the study, scientists performed blood tests on 80 patients hospitalized for COVID-19 and then measured the patients’ levels of two different cytokines — IL-6 and IL-10 — which act as messengers for the immune system.
The study’s senior author, Gerry McElvaney, a professor of medicine at RCSI University of Medicine and Health Sciences in Ireland, tells Yahoo Life that IL-6 is a “pro-inflammatory protein,” while IL-10 is an “anti-inflammatory protein” and that both are “known to be altered in COVID-19” patients.
“IL-6 is kind of turning on the immune system, while IL-10 is one of our anti-inflammatory cytokines that tries to turn things down,” Dr. Matt Exline, a pulmonary and critical care specialist at the Ohio State University Wexner Medical Center, tells Yahoo Life. “As you’re fighting an infection, the body is trying to find an even keel” between the two. “If it’s too turned up, that’s bad,” says Exline, “and if it’s too turned down that’s also bad. I think the concept they identified [in the study] is an important one.”
The scientists noted in the study that, based on their own previous research, “pro-inflammatory cytokines,” in particular IL-6, “were increased in those with severe illness.” So having a blood test that could show a “loss of balance between pro-inflammatory and anti-inflammatory mediators in COVID-19” could signal that a patient is at a greater risk of developing a severe infection.
To rate any changes in the balance of IL-6 and IL-10, the researchers came up with a five-point linear scoring system designed to predict clinical outcomes, called the Dublin-Boston score. According to the researchers, every one-point increase in the score was associated with a 5.6 times higher risk of a more severe outcome.
According to EurekAlert: “The Dublin-Boston score can now accurately predict how severe the infection will be on day seven after measuring the patient's blood for the first four days.”
McElvaney told EurekAlert that a “more informed prognosis could help determine when to escalate or de-escalate care,” helping hospitals use resources more efficiently, adding: “The score may also have a role in evaluating whether new therapies designed to decrease inflammation in COVID-19 actually provide benefit."
He tells Yahoo Life that the scoring system is “easy to calculate and easy for clinicians to interpret. The limiting factor is that, although many hospitals and laboratories worldwide are testing for IL-6, IL-10 is less widely tested. As awareness of IL-10 grows, more hospitals and laboratories have begun to look at it, however.”
McElvaney says that he and his team “hope... that the Dublin-Boston score will help guide clinical decision-making, help identify patients who might benefit from novel therapies, and provide an objective means of measuring the response to these therapies.”
While Exline and Dr. Dean Winslow, an infectious disease specialist at Stanford Health Care, both tell Yahoo Life that the study results are “interesting,” they agree that more research is needed. “The utility of this IL-6 to IL-10 ratio would probably need to be validated in larger studies,” says Winslow, adding that researchers would have to “couple the prognostic information we get from looking at this IL-6 and IL-10 ratio… with therapeutic interventions to see how really useful it is” in helping COVID-19 patients in clinical settings.
But Exline adds that “most labs in many hospitals have these [blood tests] readily available, so if it works out [with further research], it would be something we could put into practice quickly.”
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