#VisualAbstract: Serum IL-6 and TNF-α levels identified as independent predictors of COVID-19 severity and mortality

1. Serum IL-6 and TNF-α were strong, independent predictors of disease severity and death among those with suspected and confirmed SARS-CoV-2 infection.

Evidence Rating Level: 2 (Good)

Hyperinflammatory responses, or cytokine storms, are known results of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), serving as a basis for disease severity and mortality. This cohort study from Mount Sinai Health System in New York aimed to investigate predictive biomarkers of pathogenic inflammation to better understand implicated immune pathways. Participants included 1,484 patients with either suspected (median [IQR] age = 60 [49-73], 53.9% male) or confirmed (median [IQR] age = 63 [53-72], 60.1% male) SARS-CoV-2 infection, for whom health and laboratory information was extracted from medical records. Four inflammatory cytokines known to contribute to pathogenic inflammation were measured: CAR T cell-associated CRS-IL-6, IL-8, TNF-α, and IL-1β, subsequently assessing their relationships to severity and survival. A total of 1,953 specimens were analyzed, mostly upon hospital admission (median [IQR] time = 1.2 days [0.7 to 3.0] days) using the ELLA rapid detection enzyme-linked immunosorbent assay (ELISA) microfluids platform. This study found that high serum TNF-α, IL-6 and IL-8 were strong, independent predictors of patient survival (p = 0.0140, p < 0.0001, p = 0.0205, respectively). When controlling for disease severity, hypoxia and other vitals, common lab inflammation markers, comorbidities and demographics, TNF-α and IL-6 serum levels continued to be strong predictors of mortality. Overall, this study suggests that serum levels of IL-6 and TNF-α should be considered among patients with suspected or confirmed SARS-CoV-2, which may better inform treatment and disease course.

Click to read the study in Nature

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