CYTOKINE storm is the term given to immune responses triggered by escalated infections, such as in the coronavirus disease (COVID-19). Severe immune manifestations can be observed in approximately 20–30% of patients hospitalised with COVID-19 and may lead to a cytokine storm with risks of fatal organ damage and mortality.
In a new study, researchers have developed and validated predictive criteria for early identification of patients with COVID-19 who are developing hyperimmune responses. Dr Roberto Caricchio, lead author of the study and Chief of the Section of Rheumatology, Lewis Katz School of Medicine at Temple University (LKSOM), Philadelphia, Pennsylvania, USA explained the prospect of early therapeutic intervention: “If we can anticipate a cytokine storm, we can apply treatment sooner and possibly decrease mortality.” The investigation is the first of its kind to identify criteria for clinical practice to potentially protect against the unfavourable hyperimmune attack in COVID-19.
In March of this year, the researchers performed statistical analyses on laboratory variables collected for 513 patients hospitalised with COVID-19, 64 of whom developed cytokine storm. To define predictive requirements to constitute a cytokine storm, a genetic algorithm was used. The algorithm identified cut-off values for the individual patient data and deduced variables indicating which patients were most likely to develop cytokine storm. The analyses produced six predictive criteria of three sets of laboratory results: inflammation, cell death and tissue damage, and electrolyte imbalance. Patients with cytokine storm exhibited a proinflammatory status and significant systemic tissue damage. All criteria were met within the first day of hospitalisation in almost one-half of all patients who had cytokine storm, and all patients who met the criteria had extended hospital stays and were at increased risk of death from COVID-19. The algorithm was used for a further 258 patients hospitalised for COVID-19 and correctly predicted cytokine storm in approximately 70% of patients.
Dr Caricchio explained that the criteria are applicable to at any level of hospitalisation anywhere in the world: “This makes the criteria very valuable for guiding decisions about how to treat COVID-19 patients worldwide,” concluding that broad application of the criteria could result in early diagnosis and intervention, saving many lives.