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Prompt Predicting of Early Clinical Deterioration of Moderate-to-Severe COVID-19 Patients: Usefulness of a Combined Score Using IL-6 in a Preliminary Study.
Vultaggio, Alessandra; Vivarelli, Emanuele; Virgili, Gianni; Lucenteforte, Ersilia; Bartoloni, Alessandro; Nozzoli, Carlo; Morettini, Alessandro; Berni, Andrea; Malandrino, Danilo; Rossi, Oliviero; Nencini, Francesca; Pieralli, Filippo; Peris, Adriano; Lagi, Filippo; Scocchera, Giulia; Spinicci, Michele; Trotta, Michele; Mazzetti, Marcello; Parronchi, Paola; Cosmi, Lorenzo; Liotta, Francesco; Fontanari, Paolo; Mazzoni, Alessio; Salvati, Lorenzo; Maggi, Enrico; Annunziato, Francesco; Almerigogna, Fabio; Matucci, Andrea.
  • Vultaggio A; Immunoallergology Unit, Careggi University Hospital, Florence, Italy.
  • Vivarelli E; Immunoallergology Unit, Careggi University Hospital, Florence, Italy.
  • Virgili G; Department of Ophthalmology, Careggi University Hospital, Florence, Italy.
  • Lucenteforte E; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
  • Bartoloni A; Department of Experimental and Clinical Medicine, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
  • Nozzoli C; Internal Medicine Unit 1, Careggi University Hospital, Florence, Italy.
  • Morettini A; Internal Medicine Unit 2, Careggi University Hospital, Florence, Italy.
  • Berni A; Internal Medicine Unit 3, Careggi University Hospital, Florence, Italy.
  • Malandrino D; Internal Medicine Unit 3, Careggi University Hospital, Florence, Italy.
  • Rossi O; Immunoallergology Unit, Careggi University Hospital, Florence, Italy.
  • Nencini F; Immunoallergology Unit, Careggi University Hospital, Florence, Italy.
  • Pieralli F; Intermediate Care Unit, Careggi University Hospital, Florence, Italy.
  • Peris A; Intensive Care Unit and Regional ECMO Referral Centre, Careggi University Hospital, Florence, Italy.
  • Lagi F; Department of Experimental and Clinical Medicine, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
  • Scocchera G; Internal Medicine Unit 2, Careggi University Hospital, Florence, Italy.
  • Spinicci M; Department of Experimental and Clinical Medicine, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
  • Trotta M; Department of Experimental and Clinical Medicine, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
  • Mazzetti M; Department of Experimental and Clinical Medicine, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
  • Parronchi P; Department of Experimental and Clinical Medicine, Immunology and Cell Therapy Unit, Careggi University Hospital, Florence, Italy.
  • Cosmi L; Department of Experimental and Clinical Medicine, Immunology and Cell Therapy Unit, Careggi University Hospital, Florence, Italy.
  • Liotta F; Department of Experimental and Clinical Medicine, Immunology and Cell Therapy Unit, Careggi University Hospital, Florence, Italy.
  • Fontanari P; Cardiac Anesthesia and Intensive Care Unit, Careggi University Hospital, Florence, Italy.
  • Mazzoni A; Department of Experimental and Clinical Medicine, Flow Cytometric Diagnostic Centre and Immunotherapy (CDCI), Careggi University Hospital, Florence, Italy.
  • Salvati L; Department of Experimental and Clinical Medicine, Immunology and Cell Therapy Unit, Careggi University Hospital, Florence, Italy.
  • Maggi E; Translational Immunology Unit, Immunology Area, Pediatric Hospital Bambino Gesù, IRCCS, Rome, Italy.
  • Annunziato F; Department of Experimental and Clinical Medicine, Flow Cytometric Diagnostic Centre and Immunotherapy (CDCI), Careggi University Hospital, Florence, Italy.
  • Almerigogna F; Immunoallergology Unit, Careggi University Hospital, Florence, Italy.
  • Matucci A; Immunoallergology Unit, Careggi University Hospital, Florence, Italy. Electronic address: andrea.matucci@unifi.it.
J Allergy Clin Immunol Pract ; 8(8): 2575-2581.e2, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-611996
Semantic information from SemMedBD (by NLM)
1. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
2. interleukin-6 ADMINISTERED_TO Patients
Subject
interleukin-6
Predicate
ADMINISTERED_TO
Object
Patients
3. Serum LOCATION_OF interleukin-6
Subject
Serum
Predicate
LOCATION_OF
Object
interleukin-6
4. Pneumonia PROCESS_OF Patients
Subject
Pneumonia
Predicate
PROCESS_OF
Object
Patients
5. Worse PROCESS_OF Patients
Subject
Worse
Predicate
PROCESS_OF
Object
Patients
6. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
7. interleukin-6 ADMINISTERED_TO Patients
Subject
interleukin-6
Predicate
ADMINISTERED_TO
Object
Patients
8. Serum LOCATION_OF interleukin-6
Subject
Serum
Predicate
LOCATION_OF
Object
interleukin-6
9. Pneumonia PROCESS_OF Patients
Subject
Pneumonia
Predicate
PROCESS_OF
Object
Patients
10. Worse PROCESS_OF Patients
Subject
Worse
Predicate
PROCESS_OF
Object
Patients
ABSTRACT

BACKGROUND:

The early identification of patients at risk of clinical deterioration is of interest considering the timeline of COVID-19 after the onset of symptoms.

OBJECTIVE:

The aim of our study was to evaluate the usefulness of testing serum IL-6 and other serological and clinical biomarkers, to predict a short-term negative clinical course of patients with noncritical COVID-19.

METHODS:

A total of 208 patients with noncritical COVID-19 pneumonia at admission were consecutively enrolled. Clinical and laboratory findings obtained on admission were analyzed by using survival analysis and stepwise logistic regression for variable selection. Three-day worsening as outcome in a logistic model to generate a prognostic score was used.

RESULTS:

Clinical worsening occurred in 63 patients (16 = died; 39 = transferred to intensive care unit; 8 worsening of respiratory failure). Forty-five of them worsened within 3 days after admission. The risk of clinical worsening was progressively enhanced along with increasing quartiles of IL-6 levels. Multivariate analysis showed that IL-6 (P = .005), C-reactive protein (CRP) (P = .003), and SaO2/FiO2 (P = .014) were the best predictors for clinical deterioration in the first 3 days after admission. The combined score yielded an area under the curve = 0.88 (95% confidence interval 0.83-0.93). A nomogram predicting the probability of 3-day worsening was generated. The score also showed good performance for 7-day and 14- or 21-day worsening and in predicting death occurring during all the follow-up.

CONCLUSIONS:

Combining IL-6, CRP, and SaO2/FiO2 in a score may help clinicians to identify on admission those patients with COVID-19 who are at high risk for a further 3-day clinical deterioration.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Interleukin-6 / Coronavirus Infections / Clinical Deterioration Type of study: Observational study / Prognostic study / Risk factors Limits: Adult / Aged / Female / Humans / Male / Middle aged / Young adult Language: English Journal: J Allergy Clin Immunol Pract Year: 2020 Document Type: Article Affiliation country: J.jaip.2020.06.013

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Interleukin-6 / Coronavirus Infections / Clinical Deterioration Type of study: Observational study / Prognostic study / Risk factors Limits: Adult / Aged / Female / Humans / Male / Middle aged / Young adult Language: English Journal: J Allergy Clin Immunol Pract Year: 2020 Document Type: Article Affiliation country: J.jaip.2020.06.013