In patients with severe COVID-19, the immune system can overreact leading to massively increased cytokine levels in the blood - a 'cytokine storm'. Instead of helping the body fight the virus, this overreaction is extremely damaging to the cells and tissues of the body itself and can be fatal. Identifying those more prone to this response and tackling the hyperinflammation could be a key route to reducing the severity of COVID-19 and deaths.
The study, published in Respiratory Research, analyzed blood samples from 100 COVID-19 positive patients admitted to University Hospital Southampton NHS Foundation Trust (UHS) between 20 March and 29 April 2020, during the first phase of the pandemic.
They found that high levels of cytokines IL-6, IL-8, TNF, IL-1β and IL-33 in the patients' blood on admission were associated with greater chance of needing intensive care, artificial ventilation and of dying. IL-1β and IL-33 showed the biggest effect.
This study formed part of the CoV-19POC study - a trial led by Dr Clark looking at the clinical impact of molecular point-of-care testing in patients at UHS with suspected COVID-19, including tests that dramatically cut the time taken to diagnose COVID-19.
Combining this cytokine test with a clinical assessment of the patients' condition could help doctors identify and treat those most at risk of deteriorating.
Dr Anna Freeman and Dr Hannah Burke, Respiratory Clinical Research Fellows and joint first authors commented: "This project was a great opportunity for collaboration within the Faculty of Medicine, using resource from both the respiratory and infectious diseases teams. As early career researchers this study provided us with a valuable learning opportunity about how to deliver academic impact within the evolving COVID-19 pandemic."
Two treatments for those hospitalized with COVID-19 have been found so far, with the steroid dexamethasone shown to reduce deaths by up to a third, in patients needing oxygen. The mechanism for Dexamethasone's protective effects isn't known, but as a non-specific anti-inflammatory it points to the potential benefit of controlling the inflammatory immune response.
The Southampton team hope that by accurately identifying which cytokines are driving hyperinflammation in each COVID-19 patient, doctors could target them (such as with an IL-33 blocker current in UK trials), yielding the biggest benefits for individual patients- an approach known as 'precision medicine'.
MEDICA-tradefair.com; Source: University of Southampton