Blood test could identify COVID-19 patients at risk of 'cyto
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Researchers have identified a blood profile that could help identify COVID-19 patients at greatest risk of deterioration and direct them towards trials of specific treatments that could modify their immune systems' responses.

A new study has shown a blood test for five cytokines could help predict those at risk of life-threating overstimulation of immune defences by COVID-19, and potentially tailor their treatment to tackle this.

'Preventing a cytokine storm'

Cytokines are cell signalling molecules with many associated with inflammation released into the bloodstream after an infection, helping to drive protective immune responses.

In patients with severe COVID-19, the immune system can overreact leading to massively increased cytokine levels in the blood - a 'cytokine storm'. Instead of helping the body fight the virus, this overreaction is extremely damaging to the cells and tissues of the body itself and can be fatal.

Identifying those more prone to this response, and tackling the hyperinflammation could be a key route to reducing the severity of COVID-19 and deaths.

'Identifying patients most at risk'

The study, published in Respiratory Research, analysed blood samples from 100 COVID-19 positive patients admitted to University Hospital Southampton. They found that high levels of cytokines IL-6, IL-8, TNF, IL-1? and IL-33 in the patients' blood on admission were associated with greater chance of needing intensive care, artificial ventilation and of dying. IL-1? and IL-33 showed the biggest effect.

Combining this cytokine test with a clinical assessment of the patients' condition could help doctors identify and treat those most at risk of deteriorating.

'Investigating new treatments'

Two treatments for those hospitalised with COVID-19 have been found so far, with the steroid dexamethasone shown to reduce deaths by up to a third, in patients needing oxygen. The mechanism for Dexamethasone's protective effects isn't known, but as a non-specific anti-inflammatory it points to the potential benefit of controlling the inflammatory immune response.

Researchers hope that by accurately identifying which cytokines are driving hyperinflammation in each COVID-19 patient, doctors could target them (such as with an IL-33 blocker current in UK trials), yielding the biggest benefits for individual patients- an approach known as 'precision medicine'.

Researchers said: "these findings suggest that testing for both COVID-19 and cytokines at the point-of-care is feasible and in the future may identify infected patients and the most appropriate treatment for them, in near real-time."

Source: https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-020-01511-z
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