PLoS ONE (Jan 2021)

Observational cohort study of IP-10's potential as a biomarker to aid in inflammation regulation within a clinical decision support protocol for patients with severe COVID-19.

  • Shaul Lev,
  • Tamar Gottesman,
  • Gal Sahaf Levin,
  • Doron Lederfein,
  • Evgeny Berkov,
  • Dror Diker,
  • Aliza Zaidman,
  • Amir Nutman,
  • Tahel Ilan Ber,
  • Alon Angel,
  • Lior Kellerman,
  • Eran Barash,
  • Roy Navon,
  • Olga Boico,
  • Yael Israeli,
  • Michal Rosenberg,
  • Amir Gelman,
  • Roy Kalfon,
  • Einav Simon,
  • Noa Avni,
  • Mary Hainrichson,
  • Oren Zarchin,
  • Tanya M Gottlieb,
  • Kfir Oved,
  • Eran Eden,
  • Boaz Tadmor

DOI
https://doi.org/10.1371/journal.pone.0245296
Journal volume & issue
Vol. 16, no. 1
p. e0245296

Abstract

Read online

BackgroundTreatment of severely ill COVID-19 patients requires simultaneous management of oxygenation and inflammation without compromising viral clearance. While multiple tools are available to aid oxygenation, data supporting immune biomarkers for monitoring the host-pathogen interaction across disease stages and for titrating immunomodulatory therapy is lacking.MethodsIn this single-center cohort study, we used an immunoassay platform that enables rapid and quantitative measurement of interferon γ-induced protein 10 (IP-10), a host protein involved in lung injury from virus-induced hyperinflammation. A dynamic clinical decision support protocol was followed to manage patients infected with severe acute respiratory syndrome coronavirus 2 and examine the potential utility of timely and serial measurements of IP-10 as tool in regulating inflammation.ResultsOverall, 502 IP-10 measurements were performed on 52 patients between 7 April and 10 May 2020, with 12 patients admitted to the intensive care unit. IP-10 levels correlated with COVID-19 severity scores and admission to the intensive care unit. Among patients in the intensive care unit, the number of days with IP-10 levels exceeding 1,000 pg/mL was associated with mortality. Administration of corticosteroid immunomodulatory therapy decreased IP-10 levels significantly. Only two patients presented with subsequent IP-10 flare-ups exceeding 1,000 pg/mL and died of COVID-19-related complications.ConclusionsSerial and readily available IP-10 measurements potentially represent an actionable aid in managing inflammation in COVID-19 patients and therapeutic decision-making.Trial registrationClinicaltrials.gov, NCT04389645, retrospectively registered on May 15, 2020.