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IL-6 serum levels predict severity and response to tocilizumab in COVID-19: An observational study.
Galván-Román, José María; Rodríguez-García, Sebastián C; Roy-Vallejo, Emilia; Marcos-Jiménez, Ana; Sánchez-Alonso, Santiago; Fernández-Díaz, Carlos; Alcaraz-Serna, Ana; Mateu-Albero, Tamara; Rodríguez-Cortes, Pablo; Sánchez-Cerrillo, Ildefonso; Esparcia, Laura; Martínez-Fleta, Pedro; López-Sanz, Celia; Gabrie, Ligia; Del Campo Guerola, Luciana; Suárez-Fernández, Carmen; Ancochea, Julio; Canabal, Alfonso; Albert, Patricia; Rodríguez-Serrano, Diego A; Aguilar, Juan Mariano; Del Arco, Carmen; de Los Santos, Ignacio; García-Fraile, Lucio; de la Cámara, Rafael; Serra, José María; Ramírez, Esther; Alonso, Tamara; Landete, Pedro; Soriano, Joan B; Martín-Gayo, Enrique; Fraile Torres, Arturo; Zurita Cruz, Nelly Daniela; García-Vicuña, Rosario; Cardeñoso, Laura; Sánchez-Madrid, Francisco; Alfranca, Arantzazu; Muñoz-Calleja, Cecilia; González-Álvaro, Isidoro.
  • Galván-Román JM; Internal Medicine Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Rodríguez-García SC; Rheumatology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Roy-Vallejo E; Internal Medicine Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Marcos-Jiménez A; Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Sánchez-Alonso S; Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Fernández-Díaz C; Rheumatology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Alcaraz-Serna A; Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Mateu-Albero T; Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Rodríguez-Cortes P; Internal Medicine Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Sánchez-Cerrillo I; Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Esparcia L; Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Martínez-Fleta P; Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • López-Sanz C; Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Gabrie L; Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Del Campo Guerola L; Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Suárez-Fernández C; Internal Medicine Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Ancochea J; Pneumology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Canabal A; Intensive Care Unit, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Albert P; Intensive Care Unit, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Rodríguez-Serrano DA; Intensive Care Unit, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Aguilar JM; Emergency Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Del Arco C; Emergency Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • de Los Santos I; Internal Medicine Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • García-Fraile L; Internal Medicine Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • de la Cámara R; Hematology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Serra JM; Hospital Pharmacy Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Ramírez E; Hospital Pharmacy Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Alonso T; Pneumology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Landete P; Pneumology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Soriano JB; Pneumology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Martín-Gayo E; Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Fraile Torres A; Microbiology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Zurita Cruz ND; Microbiology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • García-Vicuña R; Rheumatology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Cardeñoso L; Microbiology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Sánchez-Madrid F; Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain; Centro de Investigación Biomédica en Red - Enfermedades Cardiovasculares (CIBER CV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
  • Alfranca A; Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • Muñoz-Calleja C; Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.
  • González-Álvaro I; Rheumatology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain. Electronic address: isidoro.ga@ser.es.
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 on

outcomes:

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.
Subject(s)
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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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