An inflammatory cytokine signature predicts COVID-19 severity and survival

Nat Med. 2020 Oct;26(10):1636-1643. doi: 10.1038/s41591-020-1051-9. Epub 2020 Aug 24.

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Betacoronavirus
  • COVID-19
  • Coronavirus Infections / immunology*
  • Coronavirus Infections / mortality
  • Coronavirus Infections / physiopathology
  • Coronavirus Infections / therapy
  • Cytokines / immunology
  • Female
  • Hospitalization
  • Humans
  • Interleukin-1beta / immunology*
  • Interleukin-6 / immunology*
  • Interleukin-8 / immunology*
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / immunology*
  • Pneumonia, Viral / mortality
  • Pneumonia, Viral / physiopathology
  • Pneumonia, Viral / therapy
  • SARS-CoV-2
  • Severity of Illness Index
  • Survival Rate
  • Tumor Necrosis Factor-alpha / immunology*

Substances

  • CXCL8 protein, human
  • Cytokines
  • IL1B protein, human
  • IL6 protein, human
  • Interleukin-1beta
  • Interleukin-6
  • Interleukin-8
  • TNF protein, human
  • Tumor Necrosis Factor-alpha