Laboratory indicators of cytokine storm development in SARS-CoV-2 infection

Anca Gherasim^(1,*), Maia Mihon⁽²⁾, Teodora Ganea⁽¹⁾, Iustin Calangiu⁽¹⁾, Razvan Ionescu⁽¹⁾

1)Colentina Clinical Hospital, Bucharest, Romania
2)Cluj County Emergency Clinical Hospital, Cluj, Romania

Objective. This study aims to identify key laboratory indicators associated with the development of cytokine storm in COVID-19 patients, by assessing the predictive value of several blood parameters in a cohort of Romanian patients hospitalized with SARS-CoV-2 infection.
Methods. An analytical observational retrospective study was conducted on 219 COVID-19 patients hospitalized at Colentina Clinical Hospital, Bucharest, from March 1st, 2020, to April 1st, 2021. Patients were categorized into two groups: those who developed a cytokine storm and those who did not, based on clinical and laboratory criteria observed during their hospitalization. Data on demographics, comorbidities, and 13 laboratory parameters were collected. Statistical analysis included univariate and multivariate regression models to determine the impact of these parameters on cytokine storm development.
Results. Of the 219 patients, 68 (31%) developed a cytokine storm. Key parameters such as C-reactive protein (CRP), ferritin, absolute neutrophil count, lactate dehydrogenase (LDH), blood urea nitrogen (BUN) ratio, albumin, lymphocyte percentage and aspartate aminotransferase (AST) were significantly altered in the cytokine storm group, but only CRP, ferritin, absolute neutrophil count, LDH and BUN ratio were significant predictors of cytokine storm progression. No significant associations were found between demographic factors or comorbidities and the risk of cytokine storm development.
Conclusion. Concomitant alteration of CRP, ferritin, neutrophil count, LDH and BUN ratio are effective predictors of cytokine storm in COVID-19 patients. Early identification of these markers variation can aid in clinical decision-making and improve patient management.

Keywords: COVID-19, SARS-CoV-2, cytokine storm, predictive parameters, progression

Corresponding author(s): Anca Gherasim, 3rd Clinical Internal Medicine Department, Building E, GorundFloor, Colentina Clinical Hospital, 19-21 Stefan cel Mare road, Secotr 2, Bucharest, email: gherasim.anca96@yahoo.com