Spy molecules could guide doctors in trying to predict which Covid patients with the worst prognosis, that is, at risk of developing serious illness and dying. These were discovered by Italian researchers and their research work is presented at the European Congress of Clinical Microbiology and Infectious Diseases (Eccmid 2022) scheduled in Lisbon, Portugal, from 23 to 26 April. Experts have identified a number of cytokines that can help identify who is at greater risk. An overreaction of the immune system, in which excessive levels of proteins called cytokines produce harmful levels of inflammation, can lead to organ failure and death in patients with Covid. But what is not known is which cytokines drive this process. Being able to measure the levels of these ‘spy’ molecules when patients are hospitalized would help identify those most at risk and tailor their therapy. With this aim, Emanuela Sozio, from the Infectious Diseases Clinic of the Friuli Centrale University Healthcare Company in Udine, and colleagues from the Laboratory Medicine Department, conducted a retrospective study on 415 patients (65.5% males) hospitalized with Covid-19. between May 2020 and March 2021. The cohort included patients with disease of all severity levels, who were classified as having mild / moderate or severe / critical illness, according to the WHO (World Health Organization) definition. Average age: 70 years. 15.7% died in hospital and 23.6% had a negative outcome (orotracheal intubation and / or death). Serum levels of a wide range of cytokines were measured at admission and compared with patient outcomes, in combination with other biomarkers such as C-reactive protein (Pcr) and another identified by the abbreviation Mr-proAdm. The researchers were able to construct a decision tree (a type of flow chart) that allowed them to predict patients at risk of failing, based on the levels of cytokines and other biomarkers in their blood. The analysis revealed that high levels of IP-10 upon admission can signal an excessive immune response that can lead the patient to develop pulmonary fibrosis and require intubation. A further discovery was that high levels of IL-6, a pro-inflammatory cytokine, may be accompanied by high levels of two other substances, Sil2ra and IL-10, which have an anti-inflammatory role. This is important, because in these cases, the immunosuppressive drugs normally used to treat severe Covid could do more harm than good, experts note. “It is not always possible to determine which Covid patients have the worst prognosis, especially in the early stage,” he reflects. Sozio who explored the predictive potential of cytokines also in another study presented at Eccmid and conducted in collaboration with the International School of Advanced Studies (Sissa) of Trieste. “It is becoming increasingly clear, however, that the sooner we treat excessive inflammation, the more likely it is to deactivate it quickly and permanently, thus avoiding irreversible organ damage – he continues – Our work can help select patients with prognosis. worse “that they need to be admitted to higher-intensity care units,” as well as potentially helping to personalize their treatment. “