- A novel prognostic tool dubbed the Dublin-Boston score significantly outperforms tracking IL-6 changes alone in determining risk for severe clinical outcomes in COVID-19.
- The score is based in part on the 4-day change in the IL-6:IL-10 ratio.
Why this matters
- Longitudinal measures of cytokine balance alterations may be more accurate than absolute IL-6 levels for predicting clinical decline in hospitalized COVID-19 patients.
- 80 hospitalized patients; mean (±standard deviation) age, 58 (±17) years; mean symptom duration, 2 (±2) days.
- Baseline: 88% on oxygen support.
- 24 invasively ventilated, 19 noninvasively ventilated/on high-flow oxygen, 27 on low-flow cannula.
- Each 0.1-unit increase in the IL-6:IL-10 ratio across days 0-4 was linked to more severe clinical outcome:
- OR, 1.28 (P=9.3×10−8).
- More severe clinical outcomes also seen for each 10-unit IL-6 increase across days 0-4:
- OR, 1.14 (P=6.2×10− 5 ).
- Using the Dublin-Boston score, severe outcomes risk increased for every 1-point increase:
- OR, 5.62 (P=1.2×10−9 ).
- At day 7, the association with clinical outcome was consistent across the patient spectrum, and the ratio slope and 4-day change in ratio were similar when stratified by clinical location.
- Prospective cohort analysis.
- Dublin-Boston score was calculated as follows: days 0-4 change in IL-6:IL-10 ratio multiplied by 2, rounded to a whole number, and restricted to a 5-point scale (−2 to 2); higher score=worse prognosis.
- Funding: American Thoracic Society; others.
- Small sample size, no replication cohort.
- Limited generalizability.
- Asymptomatic patients not included.