• Diane Marie Del Valle, Seunghee Kim-Schulze, Hsin-Hui Huang, Noam D Beckmann, Sharon Nirenberg, Bo Wang, Yonit Lavin, Talia H Swartz, Deepu Madduri, Aryeh Stock, Thomas U Marron, Hui Xie, Manishkumar Patel, Kevin Tuballes, Oliver Van Oekelen, Adeeb Rahman, Patricia Kovatch, Judith A Aberg, Eric Schadt, Sundar Jagannath, Madhu Mazumdar, Alexander W Charney, Adolfo Firpo-Betancourt, Damodara Rao Mendu, Jeffrey Jhang, David Reich, Keith Sigel, Carlos Cordon-Cardo, Marc Feldmann, Samir Parekh, Miriam Merad, and Sacha Gnjatic.
• Human Immune Monitoring Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
• Nat. Med. 2020 Oct 1; 26 (10): 1636-1643.

AbstractSeveral 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.

33 keywords...

hide…