P. Nigrovic
Annals of the Rheumatic Diseases, 2020
It is now almost difficult to imagine back to a time before COVID-19 turned the world upside down. The pandemic has taken an enormous toll on patients, families and communities, working fundamental changes into our lives and into our thoughts. The medical community has formed one of many ‘front lines’ in the battle against COVID-19, and our lives and thoughts have been transformed as well. When the COVID-19 story is told, a key subplot will be how physicians and scientists responded to the virus. The report by Caricchio et al 1 in Annals gives us opportunity to consider the medical response to COVID-19, both at a practical level and with respect to the evolving concept of COVID-associated cytokine storm.1 These investigators confronted the pandemic at Temple University, in Philadelphia, one of the early epicentres of COVID-19 in the USA. In a period of 5 weeks beginning in March 2020, the Temple team admitted more than 500 adults with characteristic pulmonary ground-glass opacities, all requiring supplemental oxygen and most positive for SARS-CoV-2 by qPCR. Despite this onslaught, the team still managed to collect and analyse data to ask whether clinical or laboratory parameters accurately predicted the severe inflammatory phenotype referred to here as the ‘COVID-19 cytokine storm’ (COVID-CS). Lacking an accepted gold standard, the investigators employed a consensus of expert rheumatologists and pulmonologists to assign 64 patients (12%) to this category, on the basis of worsening respiratory status and elevation in C reactive protein (CRP), ferritin, D-dimer, lactate dehydrogenase (LDH), and/or troponin. COVID-CS criteria were then tested in a second cohort of 258 Temple patients admitted during a 12-day period later in April. To develop their prediction model, they used univariate logistic regression to identify variables associated with COVID-CS and then principal components analysis to find predictors that clustered together, …
Cited by 7 publications.
Field of study: Medicine