Fall brought a resurgence of the coronavirus in the northern hemisphere, the so-called second COVID-19 wave that health experts anticipated. It’s not just that colder weather and lower humidity favor the spread of a virus that still quite resilient during the summer months. The virus is also taking advantage of people who are either have covid fatigue or who still deny the virus exists. Many people still think they’re safe just because they do not suffer from other medical conditions or are relatively young. While COVID-19 generally kills older people and those with preexisting conditions, there are plenty of exceptions to those rules. There’s no way to tell how your COVID-19 experience will be if you catch it. And while doctors have made significant progress when it comes to saving lives and reducing the death toll, many people still succumb to COVID-19 complications on a daily basis.
A team of doctors has devised a first of its kind COVID-19 severity score to predict the severity of the illness in individuals. Knowing in advance that a patient’s condition is about to worsen might be the kind of valuable information that can save lives. Doctors would be forewarned and could take appropriate measures in the early stages of the illness to attempt to stop the onset of complications before they arrive.
If the Dublin-Boston score proves that it can indeed save more COVID-19 patients, it might be one of the biggest breakthroughs of the coronavirus pandemic so far. It also might become just as popular as other medical scores you might be familiar with: the Apgar score that doctors use to assess the condition of newborn babies quickly. As a parent or doctor, you always want that score to be a perfect 10, which is an indication the baby does not need any sort of emergency attention after birth.
The Dublin-Boston score is named after the two hospitals that contributed to the research, RCSI, Harvard University, Beaumont Hospital in Dublin, and the Brigham and Women’s Hospital in Boston. Their study was published in The Lancet’s EBioMedicine (via ScieTechDaily).
This new prognostic score is calculated using a ratio between two markers of inflammation: interleukin-6 (IL-6) and interleukin-10 (IL-10). IL-6 is a pro-inflammatory marker and IL-10 is anti-inflammatory. The score attempts to determine cytokine fluctuations — and the term “cytokine” has been made quite popular during the pandemic. It’s the so-called “cytokine storms” that can kill patients, sending the immune response into overdrive so it attacks both infected cells and healthy tissue. “Using inflammatory cytokine balance as a means to project outcome makes mechanistic sense,” the researchers explain. “Both IL-6 and IL-10 are inextricably linked to cell metabolism, which in turn is influenced by factors such as infection, severe inflammation, hypoxia, and obesity, all of which are encountered in patients with COVID-19 who require hospitalization.”
“Both the Dublin-Boston score and the 4-day change in IL-6:IL-10 ratio significantly outperformed IL-6 alone in predicting clinical outcome at day 7,” the paper reads. A study from April indicated that raised troponin and IL-6 levels are associated with a poor COVID-19 prognosis.
The levels of IL-6 and IL-10 markers change in severe COVID-19 cases. The researchers came up with the ratio between them as well as a point system. Each 1-point increase is means that a more severe outcome is 5.6 times more likely. The higher the score, the worse the prognosis.
The scientists selected 80 patients for the study, and their treating physicians were blind to the levels of IL-6 and IL-10 or the Dublin-Boston score while attending them. This way, they wouldn’t adapt the therapies based on those measurements.
“The Dublin-Boston score is easily calculated and can be applied to all hospitalized Covid-19 patients,” RCSI Professor of Medicine Gerry McElvaney told SciTechDaily. “More informed prognosis could help determine when to escalate or de-escalate care, a key component of the efficient allocation of resources during the current pandemic. The score may also have a role in evaluating whether new therapies designed to decrease inflammation in Covid-19 actually provide benefit.”
As with other COVID-19 studies, more research might be required to verify whether the Dublin-Boston score can save lives. For example, the researchers also warn of the risks involved in attempting to correct the value of the ratio with treatment. “While the Dublin-Boston score and changes in the IL-6:IL-10 ratio both predict clinical outcome and give an insight into the pathogenesis of COVID-19 inflammation, we emphasize that these data alone do not support attempts to manipulate the ratio directly as a therapeutic target. Although IL-6 may contribute to organ injury and death in sepsis syndromes, it is also required for innate immunity and microbial clearance. Imprecise inhibition of the pro-inflammatory effects may therefore represent a double-edged sword.”
Whether or not it works, researchers will not stop looking for markers that might allow them to predict severe COVID-19 complications. Other ideas already exist, including a common blood test that might predict the severity of the illness.
This might be one of the biggest breakthroughs of the coronavirus pandemic The British Journal Editors and Wire Services/ BGR.