The Dublin-Boston Scoring System Predicts Severity of COVID-19 Infections

By LabMedica International staff writers
Posted on 26 Oct 2020

Image: Pro-inflammatory IL-6 is responsible for stimulating acute phase protein synthesis, as well as the production of neutrophils in the bone marrow. It supports the growth of B-cells and is antagonistic to regulatory T-cells (Photo courtesy of Wikimedia Commons)

Image: Anti-inflammatory IL-10 is a cytokine with multiple effects in immunoregulation and inflammation. It downregulates the expression of Th1 cytokines, MHC class II antigens, and co-stimulatory molecules on macrophages (Photo courtesy of Wikimedia Commons)

A newly devised scoring system was designed to help doctors identify COVID-19 patients more likely to develop severe infections with potentially life-threatening complications.

Investigators at the Royal College of Surgeons in Ireland (Dublin, Ireland) evaluated the relationship between the ratio of interleukin (IL)-6 to IL-10 and subsequent clinical outcome in 80 patients hospitalized for COVID-19. They used their findings to create a simple five-point linear score predictor of clinical outcome, the Dublin-Boston score.

The two interleukins are molecular messengers linked to the body's immune response to inflammation. In general, IL-6 is pro-inflammatory while IL-10 is anti-inflammatory.

The investigators associated the IL-6:IL-10 ratio with (a) baseline biomarker levels, (b) change in biomarker level from day 0 to day two, (c) change in biomarker from day 0 to day four, and (d) slope of biomarker change throughout the study. Based on the changes in the ratio of the two biomarkers over time, the investigators formulated a point system where each one-point increase was associated with a 5.6 times increased odds for a more severe outcome.

"The Dublin-Boston score is easily calculated and can be applied to all hospitalized COVID-19 patients," said Dr. Noel G. McElvaney, professor of medicine, at the Royal College of Surgeons in Ireland. "More informed prognosis could help determine when to escalate or deescalate care, a key component of the efficient allocation of resources during the current pandemic. The score may also have a role in evaluating whether new therapies designed to decrease inflammation in COVID-19 actually provide benefit."

The Dublin-Boston scoring system was described in the October 8, 2020, online edition of the journal EbioMedicine.

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Royal College of Surgeons in Ireland