A linear prognostic score based on the ratio of interleukin-6 to interleukin-10 predicts outcomes in COVID-19

EBioMedicine. 2020 Nov;61:103026. doi: 10.1016/j.ebiom.2020.103026. Epub 2020 Oct 8.


Background: Prognostic tools are required to guide clinical decision-making in COVID-19.

Methods: We studied the relationship between the ratio of interleukin (IL)-6 to IL-10 and clinical outcome in 80 patients hospitalized for COVID-19, and created a simple 5-point linear score predictor of clinical outcome, the Dublin-Boston score. Clinical outcome was analysed as a three-level ordinal variable ("Improved", "Unchanged", or "Declined"). For both IL-6:IL-10 ratio and IL-6 alone, we associated clinical outcome with a) baseline biomarker levels, b) change in biomarker level from day 0 to day 2, c) change in biomarker from day 0 to day 4, and d) slope of biomarker change throughout the study. The associations between ordinal clinical outcome and each of the different predictors were performed with proportional odds logistic regression. Associations were run both "unadjusted" and adjusted for age and sex. Nested cross-validation was used to identify the model for incorporation into the Dublin-Boston score.

Findings: The 4-day change in IL-6:IL-10 ratio was chosen to derive the Dublin-Boston score. Each 1 point increase in the score was associated with a 5.6 times increased odds for a more severe outcome (OR 5.62, 95% CI -3.22-9.81, P = 1.2 × 10-9). Both the Dublin-Boston score and the 4-day change in IL-6:IL-10 significantly outperformed IL-6 alone in predicting clinical outcome at day 7.

Interpretation: The Dublin-Boston score is easily calculated and can be applied to a spectrum of hospitalized COVID-19 patients. More informed prognosis could help determine when to escalate care, institute or remove mechanical ventilation, or drive considerations for therapies.

Funding: Funding was received from the Elaine Galwey Research Fellowship, American Thoracic Society, National Institutes of Health and the Parker B Francis Research Opportunity Award.

Keywords: COVID-19; Clinical outcome; Cytokines; Inflammation; Interleukin-10; Interleukin-6; Prognostic score.

MeSH terms

  • Adult
  • Aged
  • Betacoronavirus / isolation & purification
  • COVID-19
  • Coronavirus Infections / diagnosis*
  • Coronavirus Infections / pathology
  • Coronavirus Infections / virology
  • Female
  • Humans
  • Interleukin-10 / metabolism*
  • Interleukin-6 / metabolism*
  • Logistic Models
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / diagnosis*
  • Pneumonia, Viral / pathology
  • Pneumonia, Viral / virology
  • Prognosis
  • SARS-CoV-2
  • Time Factors


  • Interleukin-6
  • Interleukin-10