Major predictive risk factors for а cytokine storm in COVID-19 patients (a retrospective clinical trials)

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Abstract

Background: According to WHO, as of March 31, 2021, 127 877 462 confirmed cases of the new COVID-19 coronavirus infection were registered in the world, including 2 796 561 deaths (WHO Coronavirus Disease). COVID-19 is characterized by a wide range of clinical manifestations, from asymptomatic to a rapid progression to severe and extremely severe. Predictive biomarkers for the early detection of high-risk individuals have become a matter of great medical urgency. Aims: Search for the predictors of a cytokine storm in patients with COVID-19 infection and creation of a risk scale of this complication for practical applications. Methods: The study included 458 patients with confirmed COVID-19 infection with signs of viral lung lesions according to the computer tomography data. The patients were divided into 2 groups: those with a stable course of moderate severity (100 patients) and those with progressive moderate, severe and extremely severe course (358 patients). Results: It has been established that the main risk factors for the development of a cytokine storm in COVID-19 patients are the following: interleukin-6 concentration >23 pg/ ml, dynamics of the index on the NEWS scale ≥0, ferritin concentration >485 ng/ml, D-dimer concentration >2.1, C-reactive protein concentration >50 mg/l, number of lymphocytes in the blood <0.72×109/l, age ≥40 years. The cytokine storm incidence correlates with an increase in the number of risk factors. For the practical testing the scale was applied in 3 groups. In patients of the first group (0–1 factor) almost no cytokine storm risk was found, in the second group (2 -3 factors) the probability of the storm was 55% (increase by 35.5 times), in the third group (≥4 risk factors) it reached 96% (increase by 718 times). Conclusion: The diagnostic and monitoring criteria of a cytokine storm have been established in patients with COVID-19 infection. The developed prognostic scale allows identification of patients at high risk of developing a cytokine storm so that early anti-inflammatory therapy could be started.

About the authors

Anna Yu. Anisenkova

Saint-Petersburg City Hospital No 40 of Kurortny District; Saint-Petersburg State University

Author for correspondence.
Email: anna_anisenkova@list.ru
ORCID iD: 0000-0001-5642-621X

к.м.н., доцент

Russian Federation, 9Б Borisova st., 197706, Saint Petersburg, Sestroretsk; Saint Petersburg

Svetlana V. Apalko

Saint-Petersburg City Hospital No 40 of Kurortny District

Email: svetlana.apalko@gmail.com
ORCID iD: 0000-0002-3853-4185
SPIN-code: 7053-2507

Cand. Sci. (Biol.)

Russian Federation, Saint Petersburg

Zakhar P. Asaulenko

Saint-Petersburg City Hospital No 40 of Kurortny District; North-Western State Medical University named after I.I. Mechnikov

Email: zakhariy@list.ru
ORCID iD: 0000-0001-7062-065X

MD

Russian Federation, 9Б Borisova st., 197706, Saint Petersburg, Sestroretsk; Saint Petersburg

Alexander N. Bogdanov

Saint-Petersburg City Hospital No 40 of Kurortny District; Saint-Petersburg State University; Military Medical Academy of S.M. Kirov

Email: anbmapo2008@yandex.ru
ORCID iD: 0000-0003-1964-3690

Dr. Sci. (Med.), Professor

Russian Federation, 9Б Borisova st., 197706, Saint Petersburg, Sestroretsk; Saint Petersburg; Saint Petersburg

Dmitry A. Vologzhanin

Saint-Petersburg City Hospital No 40 of Kurortny District

Email: volog@bk.ru
ORCID iD: 0000-0002-1176-794X
SPIN-code: 7922-7302

Dr. Sci. (Med.)

Russian Federation, 9Б Borisova st., 197706, Saint Petersburg, Sestroretsk

Evgenii Y. Garbuzov

Saint-Petersburg City Hospital No 40 of Kurortny District

Email: eugarbouzov@mail.ru
ORCID iD: 0000-0003-2990-0320

MD

Russian Federation, 9Б Borisova st., 197706, Saint Petersburg, Sestroretsk

Oleg S. Glotov

Saint-Petersburg City Hospital No 40 of Kurortny District

Email: olglotov@mail.ru
ORCID iD: 0000-0002-0091-2224

Cand. Sci. (Biol.)

Russian Federation, 9Б Borisova st., 197706, Saint Petersburg, Sestroretsk

Tatyana A. Kamilova

Saint-Petersburg City Hospital No 40 of Kurortny District

Email: kamilovaspb@mail.ru
ORCID iD: 0000-0001-6360-132X
SPIN-code: 2922-4404

Cand. Sci. (Biol.)

Russian Federation, 9Б Borisova st., 197706, Saint Petersburg, Sestroretsk

Olga A. Klitsenko

North-Western State Medical University named after I.I. Mechnikov

Email: olkl@yandex.ru
ORCID iD: 0000-0002-2686-8786
SPIN-code: 7354-3080

Cand. Sci. (Biol.), Associate Professor

Russian Federation, Saint Petersburg

Evdokiia M. Minina

Saint-Petersburg City Hospital No 40 of Kurortny District

Email: dulsik@list.ru
ORCID iD: 0000-0002-2606-7057
Russian Federation, 9Б Borisova st., 197706, Saint Petersburg, Sestroretsk

Sergei V. Mosenko

Saint-Petersburg City Hospital No 40 of Kurortny District

Email: neurologist@mail.ru
ORCID iD: 0000-0002-1357-4324

Cand, Sci (Med.)

Russian Federation, 9Б Borisova st., 197706, Saint Petersburg, Sestroretsk

Dmitry N. Khobotnikov

Saint-Petersburg City Hospital No 40 of Kurortny District

Email: Xobotnikov@bk.ru
ORCID iD: 0000-0002-2943-9004

MD

Russian Federation, 9Б Borisova st., 197706, Saint Petersburg, Sestroretsk

Sergey G. Sсherbak

Saint-Petersburg City Hospital No 40 of Kurortny District; Saint-Petersburg State University

Email: b40@zdrav.spb.ru
ORCID iD: 0000-0001-5047-2792
SPIN-code: 1537-9822

Dr. Sci. (Med.), Professor

Russian Federation, 9Б Borisova st., 197706, Saint Petersburg, Sestroretsk; Saint Petersburg

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2. Fig. 1. Increase of the cytokine storm risk with the unfavorable values of indices.

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3. Fig. 2. Cytokine storm incidence for a different number of risk factors.

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Copyright (c) 2021 Anisenkova A.Y., Apalko S.V., Asaulenko Z.P., Bogdanov A.N., Vologzhanin D.A., Garbuzov E.Y., Glotov O.S., Kamilova T.A., Klitsenko O.A., Minina E.M., Mosenko S.V., Khobotnikov D.N., Sсherbak S.G.

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