Laboratory biomarkers associated with COVID-19 severity and management

S Keddie; O Ziff; M K L Chou; R L Taylor; A Heslegrave; E Garr; N Lakdawala; A Church; D Ludwig; J Manson; M Scully; E Nastouli; M D Chapman; M Hart; M P Lunn

doi:10.1016/j.clim.2020.108614

Laboratory biomarkers associated with COVID-19 severity and management

Clin Immunol. 2020 Dec:221:108614. doi: 10.1016/j.clim.2020.108614. Epub 2020 Oct 22.

Authors

S Keddie¹, O Ziff², M K L Chou², R L Taylor², A Heslegrave³, E Garr², N Lakdawala², A Church², D Ludwig⁴, J Manson⁴, M Scully⁵, E Nastouli⁶, M D Chapman², M Hart², M P Lunn²

Affiliations

¹ Neuroimmunology and CSF laboratory, University College London Hospitals NHS Trust National Hospital of Neurology and Neurosurgery, Queen Square, London, UK. Electronic address: stephen.keddie@nhs.net.
² Neuroimmunology and CSF laboratory, University College London Hospitals NHS Trust National Hospital of Neurology and Neurosurgery, Queen Square, London, UK.
³ UK Dementia Research Institute, University College London, London, UK.
⁴ Department of Rheumatology, University College London Hospitals NHS Trust, London, UK.
⁵ Department of Haematology, University College London Hospitals NHS Foundation Trust and Cardiometabolic Programme-NIHR UCLH/UC BRC, London, UK.
⁶ Infection control department, University College London Hospitals NHS Trust, London, UK.

Abstract

The heterogeneous disease course of COVID-19 is unpredictable, ranging from mild self-limiting symptoms to cytokine storms, acute respiratory distress syndrome (ARDS), multi-organ failure and death. Identification of high-risk cases will enable appropriate intervention and escalation. This study investigates the routine laboratory tests and cytokines implicated in COVID-19 for their potential application as biomarkers of disease severity, respiratory failure and need of higher-level care. From analysis of 203 samples, CRP, IL-6, IL-10 and LDH were most strongly correlated with the WHO ordinal scale of illness severity, the fraction of inspired oxygen delivery, radiological evidence of ARDS and level of respiratory support (p ≤ 0.001). IL-6 levels of ≥3.27 pg/ml provide a sensitivity of 0.87 and specificity of 0.64 for a requirement of ventilation, and a CRP of ≥37 mg/l of 0.91 and 0.66. Reliable stratification of high-risk cases has significant implications on patient triage, resource management and potentially the initiation of novel therapies in severe patients.

Keywords: Biomarkers; COVID-19; CRP; Cytokines; IL-10; IL-6; Intensive care; LDH.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Biomarkers / blood
C-Reactive Protein / metabolism*
COVID-19 / blood
COVID-19 / diagnosis*
COVID-19 / therapy
COVID-19 / virology
Cytokine Release Syndrome / blood
Cytokine Release Syndrome / diagnosis*
Cytokine Release Syndrome / therapy
Cytokine Release Syndrome / virology
Female
Hospitalization
Humans
Interleukin-10 / blood
Interleukin-6 / blood*
L-Lactate Dehydrogenase / blood
Male
Middle Aged
Respiration, Artificial
Respiratory Distress Syndrome / blood
Respiratory Distress Syndrome / diagnosis*
Respiratory Distress Syndrome / therapy
Respiratory Distress Syndrome / virology
Risk Factors
SARS-CoV-2 / pathogenicity*
Severity of Illness Index

Substances

Biomarkers
IL10 protein, human
IL6 protein, human
Interleukin-6
Interleukin-10
C-Reactive Protein
L-Lactate Dehydrogenase