Combined Cytokine Scores Assessed at Emergency Department Presentation Predicts COVID-19 Critical Illness

We studied 50 COVID-19 patients (60% males; median age, 50.5 years, interquartile range, 40.5-66.0 years), 32 (64%) requiring hospitalization within 30 days of emergency department (ED visit), 14 (28%) requiring intensive care unit (ICU) admission, and 8 (16%) requiring renal replacement therapy (RRT). The results are shown in Figure 1. Both IL-6*IL-10 and IL-6*IL-8*IL-10 scores displayed similar predictive performance across the outcomes. IL-6*IL-10 displayed the most optimal performance for predicting the primary outcome (ICU admission) with an AUC of 0.89 (95%CI: 0.78 – 0.99).We found an [IL-6]×[IL-10] area under the curve (AUC) of 0.89 for predicting ICU admission, identical to that reported by Nagant et al. Given that [IL-6]×[IL-10] and [IL-6]×[IL-8]×[IL-10] displayed similar predictive performance, we suggest the use of [IL-6]×[IL-10] score, as it requires only 2 variables and is simpler to calculate, as well as more cost-effective. The combined use of IL-6 and IL-10 enables identification of patients with predominant hyperinflammatory response, as well as those who with predominant hypoinflammatory response, both conditions which significantly contribute to development of severe disease.