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Preliminary predictive criteria for COVID-19 cytokine storm.
Caricchio, Roberto; Gallucci, Marcello; Dass, Chandra; Zhang, Xinyan; Gallucci, Stefania; Fleece, David; Bromberg, Michael; Criner, Gerard J.
Afiliación
  • Caricchio R; Medicine/Rheumatology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA roc@temple.edu.
  • Gallucci M; Department of Psychology, University of Milano-Bicocca, Milan, Italy.
  • Dass C; Radiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
  • Zhang X; Medicine/Rheumatology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
  • Gallucci S; Microbiology and Immunology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
  • Fleece D; Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
  • Bromberg M; Medicine/Hematology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
  • Criner GJ; Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
Ann Rheum Dis ; 80(1): 88-95, 2021 01.
Article en En | MEDLINE | ID: mdl-32978237
OBJECTIVES: To develop predictive criteria for COVID-19-associated cytokine storm (CS), a severe hyperimmune response that results in organ damage in some patients infected with COVID-19. We hypothesised that criteria for inflammation and cell death would predict this type of CS. METHODS: We analysed 513 hospitalised patients who were positive for COVID-19 reverse transcriptase PCR and for ground-glass opacity by chest high-resolution CT. To achieve an early diagnosis, we analysed the laboratory results of the first 7 days of hospitalisation. We implemented logistic regression and principal component analysis to determine the predictive criteria. We used a 'genetic algorithm' to derive the cut-offs for each laboratory result. We validated the criteria with a second cohort of 258 patients. RESULTS: We found that the criteria for macrophage activation syndrome, haemophagocytic lymphohistiocytosis and the HScore did not identify the COVID-19 cytokine storm (COVID-CS). We developed new predictive criteria, with sensitivity and specificity of 0.85 and 0.80, respectively, comprising three clusters of laboratory results that involve (1) inflammation, (2) cell death and tissue damage, and (3) prerenal electrolyte imbalance. The criteria identified patients with longer hospitalisation and increased mortality. These results highlight the relevance of hyperinflammation and tissue damage in the COVID-CS. CONCLUSIONS: We propose new early predictive criteria to identify the CS occurring in patients with COVID-19. The criteria can be readily used in clinical practice to determine the need for an early therapeutic regimen, block the hyperimmune response and possibly decrease mortality.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Síndrome de Liberación de Citoquinas / COVID-19 Tipo de estudio: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies / Screening_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Ann Rheum Dis Año: 2021 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Síndrome de Liberación de Citoquinas / COVID-19 Tipo de estudio: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies / Screening_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Ann Rheum Dis Año: 2021 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido