Researchers at Intermountain Healthcare in Salt Lake City have developed a new clinical tool to accurately identify and diagnose COVID-19 patients who are at high risk of developing a serious inflammatory condition that can damage the lungs and other organs.
The new tool is a diagnostic clinical score that is used to determine whether patients with the virus are at increased risk of developing the condition, known as hyperinflammatory syndrome.
It’s also sometimes referred to as a “cytokine storm” and can cause the immune system to react in an inappropriate and excessive way causing significant damage to organs.
Diagnosing hyperinflammatory syndrome is very important. With the new scoring diagnostic criteria, clinicians can now identify patients early, and ideally prescribe treatments before the condition progresses and causes patients to deteriorate to critical levels.
Intermountain researchers studied the accuracy of the diagnostic tool as part of a new study published in today’s issue of the British medical journal, The Lancet Rheumatology.
For the study, researchers applied the new cHIS diagnostic score to 299 patients admitted to Intermountain hospitals with severe COVID-19. They found that the criteria accurately identified patients who were at high risk for deteriorating clinically and requiring high oxygen supplementation, needing to be placed on a ventilator, or potentially dying.
Researchers also found that COVID-19 patients with elevated cHIS criteria were four times more likely to require ventilator support.
“The prognostic value of the cHIS score is important because it can help doctors identify patients who are at risk of progressing to a much more severe and serious disease state before it happens,” said Brandon Webb, MD, an infectious diseases physician at Intermountain Healthcare and principal investigator of the study.
Samuel Brown, MD, a critical care physician at Intermountain and co-investigator on the study, says that knowing which COVID-19 patients are vulnerable to hyperinflammatory syndrome also helps enhance treatment in other ways.
“The cHIS score is also important in two other ways,” explained Dr. Brown. “First, it will help us design clinical trials targeting the patients for whom new drugs are most likely to work. Secondly, it allows us to now tailor our treatment strategy to give the right drugs to the right patients who are most likely to benefit.”
In an accompanying editorial, also published in The Lancet Rheumatology, Drs. Randy Cron, Grant Schulert, and Rachel Tatersall, praised the work done by the Intermountain research team.
“Dr. Webb and colleagues are the first to report cytokine storm syndrome clinical criteria specific to COVID-19 in the form of cHIS,” the editorial said. “Importantly, these criteria are relatively standard assessments that are readily available, timely, and not cost-prohibitive for most countries. These criteria will need validation, but for now, should help clinicians to recognize cytokine storm syndrome in the setting of COVID-19 for early initiation of potentially life-saving immunotherapy.”
Members of the Intermountain research team include: Webb, Ithan Peltan, Paul Jensen, Daanish Hoda, Bradley Hunter, Aaron Silver, Nathan Starr, Whitney Buckel, Nancy Grisel, Erika Hummel, Gregory Snow, Dave Morris, Eddie Stenehjem, Raj Srivastava and Samuel M Brown.