Preliminary predictive criteria for COVID-19 cytokine storm
Open accessAbstract
Objectives To develop predictive criteria for COVID-19-associated cytokine storm (CS), a severe hyperimmune response that results in organ damage in some patients infected with COVID-19. We hypothesised that criteria for inflammation and cell death would predict this type of CS.Methods We analysed 513 hospitalised patients who were positive for COVID-19 reverse transcriptase PCR and for ground-glass opacity by chest high-resolution CT. To achieve an early diagnosis, we analysed the laboratory results of the first 7 days of hospitalisation. We implemented logistic regression and principal component analysis to determine the predictive criteria. We used a 'genetic algorithm' to derive the cut-offs for each laboratory result. We validated the criteria with a second cohort of 258 patients.Results We found that the criteria for macrophage activation syndrome, haemophagocytic lymphohistiocytosis and the HScore did not identify the COVID-19 cytokine storm (COVID-CS). We developed new predictive criteria, with sensitivity and specificity of 0.85 and 0.80, respectively, comprising three clusters of laboratory results that involve (1) inflammation, (2) cell death and tissue damage, and (3) prerenal electrolyte imbalance. The criteria identified patients with longer hospitalisation and increased mortality. These results highlight the relevance of hyperinflammation and tissue damage in the COVID-CS.Conclusions We propose new early predictive criteria to identify the CS occurring in patients with COVID-19. The criteria can be readily used in clinical practice to determine the need for an early therapeutic regimen, block the hyperimmune response and possibly decrease mortality.
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Laboratory test results reflecting hyperinflammation and tissue damage were found to predict worsening outcomes in Covid-19.
“Laboratory test results reflecting hyperinflammation and tissue damage were found to predict worsening outcomes in Covid-19.93”
From Cytokine storm (2020) · cites this paper as [93]
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- Authors
- Caricchio, R., Gallucci, M., Dass, C., Zhang, X., Gallucci, S., Fleece, D., Bromberg, M., & Criner, G. J.
- Affiliations
- Temple University (US)
- University of Milano-Bicocca (IT)
- Corresponding author
- Caricchio, Roberto
- ORCID
- Venue
- Annals of the Rheumatic Diseases
- Publisher
- Elsevier BV
- Published
- 2021-01
- Volume
- 80
- Issue
- 1
- Pages
- 88-95
- ISSN
- 0003-4967 (ISSN-L)
- OpenAlex
- W3088161102
- Cited by
- 230
- References
- 46
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 24 · 2023: 42 · 2022: 60 · 2021: 76 · 2020: 11
- FWCI
- 2.23
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Annals of the Rheumatic Diseases (publishedVersion)
- PubMed (publishedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion)
- TUScholarShare (Temple University) (submittedVersion, cc-by-nc)
- Funders
- Lupus Research Alliance (The Role of Bacterial Infections in the Pathogenes)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R56 AR072115-01)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Hematology › Autoimmune and Inflammatory Disorders Research
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Keywords
- COVID-19 pandemic, cytokine storm, hyperinflammation, predictive criteria, laboratory biomarkers, cell death, tissue damage, macrophage activation syndrome, hemophagocytic lymphohistiocytosis, H-score, mortality, early diagnosis
- MeSH terms
- Cytokine Release Syndrome, COVID-19, SARS-CoV-2, Aged, Female, Humans, Male, Middle Aged, Risk Factors, Sensitivity and Specificity, Cohort Studies
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