Optimal - The Blog

October 22, 2020

Cytokine Clues to COVID-19 Severity

Interleukin-6 and Interleukin-10 Ratio

Dicken Weatherby, N.D. and Beth Ellen DiLuglio, MS, RDN, LDN

The United States is still firmly in the grips of the coronavirus disease 2019 (COVID-19) pandemic. According to the CDC, from the week ending February 1, 2020 to the week ending October 17, 2020, COVID-19 contributed to or caused 207,882 of the 2,270,323 deaths recorded in the United States.[1] Worldwide, from December 30, 2019 through October 11, 2020 more than 30 million cases were reported with more than 1 million deaths attributed to this novel viral infection.[2]

Fortunately, researchers and clinicians are learning more about the disease, its course, and its vulnerabilities.

Clinical laboratory data is invaluable in understanding COVID-19 and a new tool has been added to the toolbox to help evaluate the cytokine storm that can accompany it.

The Dublin-Boston score is considered the first specific prognostic score for guiding clinical decision making for COVID-19.[3]

The novel score evaluates the dynamic relationship between two cytokines—interleukin-6 (IL-6) and interleukin-10 (IL-10) and predicts increased risk of an aggressive pro-inflammatory syndrome characterized by acute respiratory distress syndrome (ARDS), renal failure, shock, and arrhythmias. [4]

The Dublin-Boston score reflects the change in the ratio of IL-6 to IL-10 from day zero to day 4 and helps predict clinical outcome on day 7. It is now considered superior to measuring IL-6 alone.

Interleukin-6 is primarily pro-inflammatory and is released in response to infection, inflammation, and even cancer. It is elevated in COVID-19 and had been considered a potential biomarker for disease severity. Interleukin-10 is primarily anti-inflammatory and can help reduce damage from unbridled inflammation.

With the discovery of the Dublin-Boston score, clinicians have a finer-honed tool at their disposal. Researchers determined that for each 1 point increase in the score, there was 5.6 times increased chance for a more severe outcome.

This information will help determine need and timing for mechanical ventilation as well as adjunct therapies, our only weapons available once COVID-19 has invaded.


[1] CDC. Provisional Death Counts for Coronavirus Disease 2019 (COVID-19). Retrieved October 22, 2020 from [R]

[2] WHO Coronavirus disease (COVID-19) Global epidemiological situation. Retrieved October 22, 2020 from [R]

[3] SciTechDaily. New Blood Test Accurately Predicts Which COVID-19 Patients Will Develop Severe Infection. October 16, 2020. Retrieved October 22, 2020 from [R]

[4] McElvaney, Oliver J et al. “A linear prognostic score based on the ratio of interleukin-6 to interleukin-10 predicts outcomes in COVID-19.” EBioMedicine, vol. 61 103026. 8 Oct. 2020, doi:10.1016/j.ebiom.2020.103026 [R]

Tag(s): Conditions

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