IL-6 serum levels predict severity and response to tocilizumab in COVID-19: An observational study.
J Allergy Clin Immunol
; 147(1): 72-80.e8, 2021 01.
Article
in English
| MEDLINE | ID: covidwho-812090
ABSTRACT
BACKGROUND:
Patients with coronavirus disaese 2019 (COVID-19) can develop a cytokine release syndrome that eventually leads to acute respiratory distress syndrome requiring invasive mechanical ventilation (IMV). Because IL-6 is a relevant cytokine in acute respiratory distress syndrome, the blockade of its receptor with tocilizumab (TCZ) could reduce mortality and/or morbidity in severe COVID-19.OBJECTIVE:
We sought to determine whether baseline IL-6 serum levels can predict the need for IMV and the response to TCZ.METHODS:
A retrospective observational study was performed in hospitalized patients diagnosed with COVID-19. Clinical information and laboratory findings, including IL-6 levels, were collected approximately 3 and 9 days after admission to be matched with preadministration and postadministration of TCZ. Multivariable logistic and linear regressions and survival analysis were performed depending onoutcomes:
need for IMV, evolution of arterial oxygen tension/fraction of inspired oxygen ratio, or mortality.RESULTS:
One hundred forty-six patients were studied, predominantly males (66%); median age was 63 years. Forty-four patients (30%) required IMV, and 58 patients (40%) received treatment with TCZ. IL-6 levels greater than 30 pg/mL was the best predictor for IMV (odds ratio, 7.1; P < .001). Early administration of TCZ was associated with improvement in oxygenation (arterial oxygen tension/fraction of inspired oxygen ratio) in patients with high IL-6 (P = .048). Patients with high IL-6 not treated with TCZ showed high mortality (hazard ratio, 4.6; P = .003), as well as those with low IL-6 treated with TCZ (hazard ratio, 3.6; P = .016). No relevant serious adverse events were observed in TCZ-treated patients.CONCLUSIONS:
Baseline IL-6 greater than 30 pg/mL predicts IMV requirement in patients with COVID-19 and contributes to establish an adequate indication for TCZ administration.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Interleukin-6
/
Antibodies, Monoclonal, Humanized
/
Cytokine Release Syndrome
/
SARS-CoV-2
/
COVID-19
/
COVID-19 Drug Treatment
Type of study:
Observational study
/
Prognostic study
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
English
Journal:
J Allergy Clin Immunol
Year:
2021
Document Type:
Article
Affiliation country:
J.jaci.2020.09.018
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