IL-10 and IL-12 (P70) Levels Predict the Risk of Covid-19 Progression in Hypertensive Patients: Insights From the BRACE-CORONA Trial

Moll-Bernardes, Renata; de Sousa, Andrea Silvestre; Macedo, Ariane V. S.; Lopes, Renato D.; Vera, Narendra; Maia, Luciana C. R.; Feldman, André; Arruda, Guilherme D. A. S.; Castro, Mauro J. C.; Pimentel-Coelho, Pedro M.; de Albuquerque, Denílson C.; de Paula, Thiago Ceccatto; Furquim, Thyago A. B.; Loures, Vitor A.; Giusti, Karla G. D.; de Oliveira, Nathália M.; De Luca, Fábio A.; Kotsugai, Marisol D. M.; Domiciano, Rafael A. M.; Santos, Mayara Fraga; de Souza, Olga Ferreira; Bozza, Fernando A.; Luiz, Ronir Raggio; Medei, Emiliano

Background: Cardiovascular comorbidities such as hypertension and inflammatory response dysregulation are associated with worse COVID-19 prognoses. Different cytokines have been proposed to play vital pathophysiological roles in COVID-19 progression, but appropriate prognostic biomarkers remain lacking. We hypothesized that the combination of immunological and clinical variables at admission could predict the clinical progression of COVID-19 in hypertensive patients. Methods: The levels of biomarkers, including C-reactive protein, lymphocytes, monocytes, and a panel of 29 cytokines, were measured in blood samples from 167 hypertensive patients included in the BRACE-CORONA trial. The primary outcome was the highest score during hospitalization on the modified WHO Ordinal Scale for Clinical Improvement. The probability of progression to severe disease was estimated using a logistic regression model that included clinical variables and biomarkers associated significantly with the primary outcome. Results: During hospitalization, 13 (7.8%) patients showed progression to more severe forms of COVID-19, including three deaths. Obesity, diabetes, oxygen saturation, lung involvement on computed tomography examination, the C-reactive protein level, levels of 15 cytokines, and lymphopenia on admission were associated with progression to severe COVID-19. Elevated levels of interleukin-10 and interleukin-12 (p70) combined with two or three of the abovementioned clinical comorbidities were associated strongly with progression to severe COVID-19. The risk of progression to severe disease reached 97.5% in the presence of the five variables included in our model. Conclusions: This study demonstrated that interleukin-10 and interleukin-12 (p70) levels, in combination with clinical variables, at hospital admission are key biomarkers associated with an increased risk of disease progression in hypertensive patients with COVID-19.