{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T11:35:23Z","timestamp":1780486523801,"version":"3.54.1"},"reference-count":34,"publisher":"Walter de Gruyter GmbH","issue":"3","funder":[{"name":"University of Cincinnati College of Medicine Special Coronavirus (COVID-19) Research Pilot Grant Program"},{"name":"James Rose is funded by the NIH Pediatric Center of Excellence in Nephrology","award":["P50DK096418"],"award-info":[{"award-number":["P50DK096418"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,2,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_cclm-2020-1284_abs_001_w2aab3b7d115b1b6b1aab1c16b1Aa\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Severe coronavirus disease 2019 (COVID-19) is associated with a dysregulated immune state. While research has focused on the hyperinflammation, little research has been performed on the compensatory anti-inflammatory response. The aim of this study was to evaluate the anti-inflammatory cytokine response to COVID-19, by assessing interleukin-10 (IL-10) and IL-10\/lymphocyte count ratio and their association with outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2020-1284_abs_002_w2aab3b7d115b1b6b1aab1c16b2Aa\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adult patients presenting to the emergency department (ED) with laboratory-confirmed COVID-19 were recruited. The primary endpoint was maximum COVID-19 severity within 30\u00a0days of index ED visit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2020-1284_abs_003_w2aab3b7d115b1b6b1aab1c16b3Aa\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 52 COVID-19 patients were enrolled. IL-10 and IL-10\/lymphocyte count were significantly higher in patients with severe disease (p&lt;0.05), as well as in those who developed severe acute kidney injury (AKI) and new positive bacterial cultures (all p\u22640.01). In multivariable analysis, a one-unit increase in IL-10 and IL-10\/lymphocyte count were associated with 42% (p=0.031) and 32% (p=0.013) increased odds, respectively, of severe COVID-19. When standardized to a one-unit standard deviations scale, an increase in the IL-10 was a stronger predictor of maximum 30-day severity and severe AKI than increases in IL-6 or IL-8.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2020-1284_abs_004_w2aab3b7d115b1b6b1aab1c16b4Aa\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The hyperinflammatory response to COVID-19 is accompanied by a simultaneous anti-inflammatory response, which is associated with poor outcomes and may increase the risk of new positive bacterial cultures. IL-10 and IL-10\/lymphocyte count at ED presentation were independent predictors of COVID-19 severity. Moreover, elevated IL-10 was more strongly associated with outcomes than pro-inflammatory IL-6 or IL-8. The anti-inflammatory response in COVID-19 requires further investigation to enable more precise immunomodulatory therapy against SARS-CoV-2.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/cclm-2020-1284","type":"journal-article","created":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T15:12:34Z","timestamp":1606749154000},"page":"599-607","source":"Crossref","is-referenced-by-count":40,"title":["The anti-inflammatory cytokine response characterized by elevated interleukin-10 is a stronger predictor of severe disease and poor outcomes than the pro-inflammatory cytokine response in coronavirus disease 2019 (COVID-19)"],"prefix":"10.1515","volume":"59","author":[{"given":"Brandon Michael","family":"Henry","sequence":"first","affiliation":[{"name":"Cardiac Intensive Care Unit , The Heart Institute, Cincinnati Children\u2019s Hospital Medical Center , Cincinnati , OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie W.","family":"Benoit","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension , Cincinnati Children\u2019s Hospital Medical Center , Cincinnati , OH , USA"},{"name":"Department of Pediatrics , College of Medicine, University of Cincinnati , Cincinnati , OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Vikse","sequence":"additional","affiliation":[{"name":"Clinical Immunology Unit , Stavanger University Hospital , Stavanger , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon A.","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine , University of Cincinnati , Cincinnati , OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Pulvino","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine , University of Cincinnati , Cincinnati , OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Hoehn","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine , University of Cincinnati , Cincinnati , OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Rose","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension , Cincinnati Children\u2019s Hospital Medical Center , Cincinnati , OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Helena","family":"Santos de Oliveira","sequence":"additional","affiliation":[{"name":"Department of Statistics , Federal University of Parana , Curitiba , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9523-9054","authenticated-orcid":false,"given":"Giuseppe","family":"Lippi","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Biomedicine and Movement , Section of Clinical Biochemistry, University of Verona , Verona , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin L.","family":"Benoit","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine , University of Cincinnati , Cincinnati , OH , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2020,11,26]]},"reference":[{"key":"2023033111415843937_j_cclm-2020-1284_ref_001_w2aab3b7d115b1b6b1ab2b1b1Aa","doi-asserted-by":"crossref","unstructured":"Ragab, D, Salah Eldin, H, Taeimah, M, Khattab, R, Salem, R. 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