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If you were to catch COVID-19, would you be somewhat sick and uncomfortable for a few days or weeks? Or would you get so gravely ill that you’d need to be hospitalized and possibly need intensive care? Right now, there’s no good way to predict what might happen because the virus seems to impact different people in such different ways.
Of course, the U.S. Centers for Disease Control and Prevention already caution that certain people — including those age 65 and up, as well as people with heart disease, chronic kidney disease, chronic obstructive pulmonary disease (COPD), and diabetes, as well as certain other underlying conditions — are most likely to develop serious complications. Yet there are still plenty of younger (and supposedly healthy) people who are also getting extremely sick. What might be going on?
A new study suggests that high levels of inflammatory proteins in the bloodstream might have something to do with it.
Scientists already know that excess inflammation is problematic for a number of reasons, and that many COVID-19 patients who end up dying ultimately succumb to a “cytokine storm,” which is an immune system response to the virus characterized by out-of-control inflammation that destroys healthy tissue.
But now, emerging data suggests that doctors ought to be paying attention to inflammatory markers well before patients are fighting for their lives.
In the study, published in the journal Nature Medicine, researchers from the Mount Sinai Health System in New York measured three types of inflammatory proteins in blood samples from 1,484 people who were admitted to the hospital because of COVID-19 symptoms.
“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,” the authors wrote. “Notably, when adjusting for disease severity, common laboratory inflammation markers, hypoxia [low oxygen] 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.”
Interleukin-6 (IL-6), interleukin-8 IL-8, and tumor necrosis factor (TNF) should already be familiar to many rheumatic disease patients, as many regularly take medication to suppress one or more of these inflammatory proteins.
Whether doing so offers any protection against COVID-19 complications, however, is unclear. Rheumatic disease patients may still be at higher risk for COVID complications because they have underlying problems with their immune system, but more research is needed.
Regardless of pre-existing health issues, anyone who becomes sick enough to get hospitalized might benefit from having their health care providers pay attention to their IL-6 and TNF levels.
“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,” the authors of the Nature Medicine study concluded.
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Del Valle DM, et al. An inflammatory cytokine signature predicts COVID-19 severity and survival. Nature Medicine. August 24, 2020. doi: https://doi.org/10.1038/s41591-020-1051-9.
People with Certain Medical Conditions. Coronavirus Disease 2019 (COVID-19). U.S. Centers for Disease Control and Prevention. August 14, 2020. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html.
Walker M. Could COVID-19 ‘Inflammatory Signature’ Predict Disease Course? MedPage Today. August 25, 2020. https://www.medpagetoday.com/infectiousdisease/covid19/88265.