Elevated levels of IL-6 and CRP predict the need for mechanical ventilation in COVID-19 - 22/07/20
, Vindi Jurinovic, PhD a, d, f, ∗, Chiara Arnreich a, d, Brian J. Lipworth, MD g, Johannes C. Hellmuth, MD a, h, Michael von Bergwelt-Baildon, MD, PhD a, c, e, h, i, Matthias Klein, MD b, j, Tobias Weinberger, MD b, k, l
Benvenuto su EM|consulte, il riferimento dei professionisti della salute.
Articolo gratuito.
Si connetta per beneficiarne
Abstract |
Background |
Coronavirus disease 2019 (COVID-19) can manifest as a viral-induced hyperinflammation with multiorgan involvement. Such patients often experience rapid deterioration and need for mechanical ventilation. Currently, no prospectively validated biomarker of impending respiratory failure is available.
Objective |
We aimed to identify and prospectively validate biomarkers that allow the identification of patients in need of impending mechanical ventilation.
Methods |
Patients with COVID-19 who were hospitalized from February 29 to April 9, 2020, were analyzed for baseline clinical and laboratory findings at admission and during the disease. Data from 89 evaluable patients were available for the purpose of analysis comprising an initial evaluation cohort (n = 40) followed by a temporally separated validation cohort (n = 49).
Results |
We identified markers of inflammation, lactate dehydrogenase, and creatinine as the variables most predictive of respiratory failure in the evaluation cohort. Maximal IL-6 level before intubation showed the strongest association with the need for mechanical ventilation, followed by maximal CRP level. The respective AUC values for IL-6 and CRP levels in the evaluation cohort were 0.97 and 0.86, and they were similar in the validation cohort (0.90 and 0.83, respectively). The calculated optimal cutoff values during the course of disease from the evaluation cohort (IL-6 level > 80 pg/mL and CRP level > 97 mg/L) both correctly classified 80% of patients in the validation cohort regarding their risk of respiratory failure.
Conclusion |
The maximal level of IL-6, followed by CRP level, was highly predictive of the need for mechanical ventilation. This suggests the possibility of using IL-6 or CRP level to guide escalation of treatment in patients with COVID-19–related hyperinflammatory syndrome.
Il testo completo di questo articolo è disponibile in PDF.Key words : IL-6, CRP, COVID-19, respiratory failure, mechanical ventilation, prediction, hyperinflammation
Abbreviations used : AUC, BAL, CORKUM, COVID-19, CRP, NPV, PPV, SARS, SARS-CoV-2
Mappa
| Disclosure of potential conflict of interest: B. Lipworth reports grants and personal fees from Sanofi, AstraZeneca, and Teva; personal fees from Cipla, Glenmark, and Lupin; and research grants, consulting, advisory board, personal fees from Chiesi, outside the submitted work; in addition, he reports that his son is an employee of AstraZeneca. M. von Bergwelt-Baildon is the local principal investigator of the COVACTA-Trial (A Study to Evaluate the Safety and Efficacy of Tocilizumab in Patients with Severe COVID-19 Pneumonia [NCT04320615]; sponsored by Hoffmann-La Roche), which is currently being conducted, and he has previously received honoraria and research funding from Hoffman-La Roche unrelated to this project. M. Klein has received speaker fees from BioMerieux and served on the advisory board of BioMerieux. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 146 - N° 1
P. 128 - Luglio 2020 Ritorno al numero
Articolo precedente
- Plasma IP-10 and MCP-3 levels are highly associated with disease severity and predict the progression of COVID-19
- Yang Yang, Chenguang Shen, Jinxiu Li, Jing Yuan, Jinli Wei, Fengmin Huang, Fuxiang Wang, Guobao Li, Yanjie Li, Li Xing, Ling Peng, Minghui Yang, Mengli Cao, Haixia Zheng, Weibo Wu, Rongrong Zou, Delin Li, Zhixiang Xu, Haiyan Wang, Mingxia Zhang, Zheng Zhang, George F. Gao, Chengyu Jiang, Lei Liu, Yingxia Liu
- Ruxolitinib in treatment of severe coronavirus disease 2019 (COVID-19): A multicenter, single-blind, randomized controlled trial
- Yang Cao, Jia Wei, Liang Zou, Tiebin Jiang, Gaoxiang Wang, Liting Chen, Liang Huang, Fankai Meng, Lifang Huang, Na Wang, Xiaoxi Zhou, Hui Luo, Zekai Mao, Xing Chen, Jungang Xie, Jing Liu, Hui Cheng, Jianping Zhao, Gang Huang, Wei Wang, Jianfeng Zhou
Benvenuto su EM|consulte, il riferimento dei professionisti della salute.