Biomarker's usefulness to predict the efficacy of IL6 inhibitors and corticosteroids in the treatment of COVID19

ABSTRACT

Objective: Proper identification of patients at risk of developing serious disease in the context of SARS-CoV-2 infection, as well as the initiation of early treatment, is essential for COVID19 successful management. The main objective of this study was to evaluate the usefulness of serum biomarkers (i.e., neutrophils, lymphocytes, Creactive protein, lactate dehydrogenase, D-dimer, ferritin and interleukin-6) to predict the early response to immunosuppressant therapy in COVID19 patients. Material and/or methods: This is a case-control study nested in a retrospective cohort, which included hospitalized patients with COVID19 pneumonia and presented elevation of some pro-inflammatory parameters. Each of the individuals who died during the 28-day follow-up was defined as a case. For each case, four controls were selected, matched by age, sex and comorbidities. Results: Overall, 856 patients were included in the initial cohort. The incidence of therapeutic failure in the cohort was 14%, thus a total of 119 cases were identified. After applying a Cox regression model, high serum concentrations of LDH (>451 IU/L), ferritin (>1014 ng/mL) and D-Dimer (>1300 ng/mL) were identified as predictors of poor response to treatment. High-specific cut-off points could not be established for any of these biomarkers. Conclusions: Some inflammatory biomarkers, such as LDH, ferritin and D-dimer, may be helpful in identifying patients for whom an early immunomodulatory therapeutic intervention should be considered in the treatment of COVID19 patients with pneumonia.