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Scientists have for the first time developed a scoring system that can accurately predict which hospitalized patients will develop a severe form of coronavirus.
The blood test was developed by researchers at the RCSI University of Medicine and Health Sciences in Dublin and in the United States.
The measurement, called the “Dublin-Boston score,” is designed to allow clinicians to make more informed decisions by identifying patients who may benefit from therapies, such as steroids, including dexamethasone, and admission to intensive care units.
Prior to this, no coronavirus-specific “prognostic scores” were available to guide clinical decision-making. The Dublin-Boston score can now accurately predict how severe the infection will be on day seven, after measuring the patient’s blood for the first four days.
The blood test works by measuring the levels of two molecules that send messages to the body’s immune system and control inflammation.
Infection
One of these molecules, interleukin (IL-6), plays a central role in the body’s defense against infection. Another form of interleukin (IL-10) has potent anti-inflammatory properties that play a central role in limiting the host’s immune response to pathogens, thus preventing damage to human cells. The levels of both proteins, which are known as cytokines, are altered in patients with severe coronavirus.
Based on changes in the ratio of these two molecules over time, the researchers developed a point system “in which each 1-point increase was associated with a 5.6 times greater probability of a more severe outcome.” Their findings are published in the Lancet EBioMedicine research journal.
“The Dublin-Boston score is easily calculated and can be applied to all hospitalized Covid-19 patients,” said RCSI professor of medicine Gerry McElvaney, lead author of the study and consultant at Beaumont Hospital.
“A more informed forecast could help determine when to scale up or down care, a key component of efficient resource allocation during the current pandemic,” he explained.
“The score may also play a role in evaluating whether new therapies designed to decrease inflammation in Covid-19 actually provide benefits.”
Limitations
The Dublin-Boston score uses the ratio of IL-6 to IL-10 because it significantly outperformed the measurement of change in IL-6 alone, he said. Despite high blood levels, IL-6 levels within the same patient vary throughout a given day, and the magnitude of the IL-6 response to infection varies between different patients.
The Dublin-Boston score was developed with significant input from researchers at Harvard University and Brigham and Women’s Hospital in Boston, USA.
This study has inherent limitations, the researchers admit. “While the number of patients is more than triple that in previous similar studies in patients with medical conditions, the sample size is still small.”
They added: “A more informed prognosis could help determine when to escalate care, guide clinicians seeking to institute or eliminate mechanical ventilation, or drive considerations for therapies. The punctuation described here is a first step in this direction. “
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