Irish help to develop first-ever Covid-19 severity prediction score

Measurement designed to enable clinicians make more informed decisions when identifying likely beneficiaries from therapies

The first-ever score to predict which patients will develop a severe form of Covid-19 has been developed by scientists working in Ireland and the United States.

The measurement, called the Dublin-Boston score, has been designed to enable clinicians to make more informed decisions when identifying patients who may benefit from therapies, such as steroids, and admission to intensive care units.

Beforehand, no Covid-19-specific prognostic scores were available to guide clinical decision-making.

The Dublin-Boston score will accurately predict how severe the infection will be on day seven by measuring the levels of two molecules that send messages to the body’s immune system and control inflammation.

Details of the study, led by researchers at the Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, has been published in October’s The Lancet’s translational research journal EBioMedicine (Ebiom).

One of the molecules, interleukin (IL)-6, is pro-inflammatory; the other, called IL-10, is anti-inflammatory.

The levels of both are altered in severe Covid-19 patients.

Based on the changes in the ratio of these two molecules over time, the researchers developed a point system where each one-point increase was associated with 5.6 times increased odds for a more severe outcome.

“The Dublin-Boston score is easily calculated and can be applied to all hospitalised Covid-19 patients,” said Prof Gerry McElvaney, Professor of Medicine at the RCSI, the study’s senior author and a consultant in Beaumont Hospital, Dublin.

“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.”

The Dublin-Boston score uses the ratio of IL-6 to IL-10 because it significantly outperformed measuring the change in IL-6 alone.

Despite high levels in blood, using only IL-6 measurements as a Covid-19 prognostic tool is hindered by several factors. IL-6 levels within the same patient vary over the course of any given day, and the magnitude of the IL-6 response to infection varies between different patients.

The Dublin-Boston score was developed by researchers from the RCSI and Beaumont Hospital, both in Dublin, Harvard University in Michigan, and the Brigham and Women’s Hospital in Boston, both in the United States.

Ebiom, published online.

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