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Combining IL-6 and SARS-CoV-2 RNAaemia-based risk stratification for fatal outcomes of COVID-19.
Saji, Ryo; Nishii, Mototsugu; Sakai, Kazuya; Miyakawa, Kei; Yamaoka, Yutaro; Ban, Tatsuma; Abe, Takeru; Ohyama, Yutaro; Nakajima, Kento; Hiromi, Taro; Matsumura, Reo; Suzuki, Naoya; Taniguchi, Hayato; Otsuka, Tsuyoshi; Oi, Yasufumi; Ogawa, Fumihiro; Uchiyama, Munehito; Takahashi, Kohei; Iwashita, Masayuki; Kimura, Yayoi; Fujii, Satoshi; Furuya, Ryosuke; Tamura, Tomohiko; Ryo, Akihide; Takeuchi, Ichiro.
  • Saji R; Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
  • Nishii M; Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
  • Sakai K; Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
  • Miyakawa K; Department of Microbiology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
  • Yamaoka Y; Department of Microbiology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
  • Ban T; Life Science Laboratory, Technology and Development Division, Kanto Chemical Co., Inc., Isehara, Kanagawa, Japan.
  • Abe T; Department of Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
  • Ohyama Y; Department of Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan.
  • Nakajima K; Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
  • Hiromi T; Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
  • Matsumura R; Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
  • Suzuki N; Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
  • Taniguchi H; Department of Critical Care and Emergency Medicine, National Hospital Organization Yokohama Medical Center, Yokohama, Kanagawa, Japan.
  • Otsuka T; Department of Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan.
  • Oi Y; Department of Critical Care and Emergency Medicine, National Hospital Organization Yokohama Medical Center, Yokohama, Kanagawa, Japan.
  • Ogawa F; Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
  • Uchiyama M; Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
  • Takahashi K; Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
  • Iwashita M; Department of Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan.
  • Kimura Y; Department of Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan.
  • Fujii S; Department of Advanced Medical Research Center, Yokohama City University, School of Medicine, Yokohama, Kanagawa, Japan.
  • Furuya R; Department of Molecular Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
  • Tamura T; Department of Critical Care and Emergency Medicine, National Hospital Organization Yokohama Medical Center, Yokohama, Kanagawa, Japan.
  • Ryo A; Department of Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
  • Takeuchi I; Department of Advanced Medical Research Center, Yokohama City University, School of Medicine, Yokohama, Kanagawa, Japan.
PLoS One ; 16(8): e0256022, 2021.
Article in English | MEDLINE | ID: covidwho-1352710
ABSTRACT

BACKGROUND:

The coronavirus disease 2019 (COVID-19) pandemic rapidly increases the use of mechanical ventilation (MV). Such cases further require extracorporeal membrane oxygenation (ECMO) and have a high mortality.

OBJECTIVE:

We aimed to identify prognostic biomarkers pathophysiologically reflecting future deterioration of COVID-19.

METHODS:

Clinical, laboratory, and outcome data were collected from 102 patients with moderate to severe COVID-19. Interleukin (IL)-6 level and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA copy number in plasma were assessed with ELISA kit and quantitative PCR.

RESULTS:

Twelve patients died or required ECMO owing to acute respiratory distress syndrome despite the use of MV. Among various variables, a ratio of oxygen saturation to fraction of inspired oxygen (SpO2/FiO2), IL-6, and SARS-CoV-2 RNA on admission before intubation were strongly predictive of fatal outcomes after the MV use. Moreover, among these variables, combining SpO2/FiO2, IL-6, and SARS-CoV-2 RNA showed the highest accuracy (area under the curve 0.934). In patients with low SpO2/FiO2 (< 261), fatal event-rate after the MV use at the 30-day was significantly higher in patients with high IL-6 (> 49 pg/mL) and SARS-CoV-2 RNAaemia (> 1.5 copies/µL) compared to those with high IL-6 or RNAaemia or without high IL-6 and RNAaemia (88% vs. 22% or 8%, log-rank test P = 0.0097 or P < 0.0001, respectively).

CONCLUSIONS:

Combining SpO2/FiO2 with high IL-6 and SARS-CoV-2 RNAaemia which reflect hyperinflammation and viral overload allows accurately and before intubation identifying COVID-19 patients at high risk for ECMO use or in-hospital death despite the use of MV.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: RNA, Viral / Interleukin-6 / SARS-CoV-2 / COVID-19 Subject: RNA, Viral / Interleukin-6 / SARS-CoV-2 / COVID-19 Type of study: Etiology study / Observational study / Prognostic study / Risk factors Language: English Journal: PLoS One Clinical aspect: Etiology / Prediction / Prognosis Year: 2021

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: RNA, Viral / Interleukin-6 / SARS-CoV-2 / COVID-19 Subject: RNA, Viral / Interleukin-6 / SARS-CoV-2 / COVID-19 Type of study: Etiology study / Observational study / Prognostic study / Risk factors Language: English Journal: PLoS One Clinical aspect: Etiology / Prediction / Prognosis Year: 2021
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