IL-6 serum levels predict severity and response to Tocilizumab in COVID-19: an observational study

Autor: José María Galván-Román, Sebastián C. Rodríguez-García, Emilia Roy-Vallejo, Ana Marcos-Jiménez, Santiago Sánchez-Alonso, Carlos Fernández-Díaz, Ana Alcaraz-Serna, Tamara Mateu-Albero, Pablo Rodríguez-Cortes, Ildefonso Sánchez-Cerrillo, Laura Esparcia, Pedro Martínez-Fleta, Celia López-Sanz, Ligia Gabrie, Luciana del Campo Guerola, Carmen Suárez-Fernández, Julio Ancochea, Alfonso Canabal, Patricia Albert, Diego A. Rodríguez-Serrano, Juan Mariano Aguilar, Carmen del Arco, Ignacio de los Santos, Lucio García-Fraile, Rafael de la Cámara, José María Serra, Esther Ramírez, Tamara Alonso, Pedro Landete, Joan B. Soriano, Enrique Martín-Gayo, Arturo Fraile Torres, Nelly Daniela Zurita Cruz, Rosario García-Vicuña, Laura Cardeñoso, Francisco Sánchez-Madrid, Arantzazu Alfranca, Cecilia Muñoz-Calleja, Isidoro González-Álvaro, Teresa Alvarado, Pablo Martínez, Francisco Javier de la Cuerda Llorente, Natalia Villalba, Mónica Negro, Elvira Contreras, Ana del Rey, Cristina Santiago, Manuel Junquera, Raquel Caminero, Francisco Javier Val, Sonia González, Marta Caño, Isabel López, Andrés von Wernitz, Bárbara Retana, Iñigo Guerra, Jorge Sorando, Lydia Chao, María José Cárdenas, Verónica Espiga, Pablo Chicharro, Pedro Rodríguez, Iñigo Hernando Alday, Miguel Sampedro, Jorge Prada, Eukene Rojo Aldama, Yolanda Real, María Caldas, Sergio Casabona, Aitor Lanas-Gimeno, Rafael de la Camara, Angela Figuera Alvárez, Beatriz Aguadol, Alberto Morell, Amparo Ibáñez Zurriaga, María Pérez Abanades, Silvia Ruiz García, Tomás Gallego Aranda, María Ruiz, Concepción Martínez Nieto, Javier Aspa, Elena Fernández, Ma José Calzada, Reyes Tejedor, Judit Iglesias, Fernando Suarez, Juan Antonio Sánchez, Beatriz Abad, Carmen Suarez, Emilia Roy, Jesus Sanz, Eduardo Sanchez, Fernando Moldenhauer, Pedro Casado, Jose Curbelo, Angela Gutierrez, Azucena Bautista, Nuria Ruiz Giménez, Angelica Fernandez, Pedro Parra, Berta Moyano, Ana Barrios, Diego Real de Asua, Beatriz Sanchez, Carmen Saez, Marianela Ciudad, Desiré Navas, Laura Cardeñoso Domingo, María del Carmen Cuevas Torresano, Diego Domingo García, Teresa Alarcón Cavero, Alicia García Blanco, Alexandra Martín Ramírez, María Auxiliadora Semiglia Chong, Ainhoa Gutiérrez Cobos, Arturo Manuel Fraile Torres, Carmen Sanchez-Gonzalez, Antonio Fernádez Perpén, Carolina Díaz Pérez, Joan Soriano, Carolina Cisneros, Elena García Castillo, Francisco Javier García Pérez, Rosa María Girón, Celeste Marcos, Enrique Zamora, Patricia García García, Santos Castañeda, Sebastián Rodríguez-García, Irene Llorente Cubas, Eva G. Tomero, Noelia García Castañeda, Ana Ma Ortiz, Cristina Valero, Miren Uriarte, Nuria Montes
Jazyk: angličtina
Rok vydání: 2020
Předmět:
0301 basic medicine
ARDS
CAR
chimeric antigen receptor
medicine.medical_treatment
Invasive Mechanical Ventilation
chemistry.chemical_compound
0302 clinical medicine
SatO2
mean oxygen saturation
Interquartile range
Fraction of inspired oxygen
Immunology and Allergy
030212 general & internal medicine
COVID-19
coronavirus disease 2019
PaO2/FiO2
arterial oxygen tension/fraction of inspired oxygen ratio
TNF
tumor necrosis factor
AUC
Area under curve
AEMPS
Spanish Agency for Drugs and Health Devices
Tocilizumab
CRS
cytokine release syndrome
PCT
procalcitonin
Cytokine release syndrome
CRP
C-reactive protein
LR
negative likelihood ratio
medicine.medical_specialty
Immunology
LR+
positive likelihood ratio
Article
03 medical and health sciences
Internal medicine
medicine
TCZ
Tocilizumab
Survival rate
ARDS
acute respiratory distress syndrome
IQR
interquartile range
Mechanical ventilation
business.industry
Interleukin-6
COVID-19
Odds ratio
PaO2
arterial oxygen tension
medicine.disease
IL
interleukin
ROC
receiver operating characteristic
030104 developmental biology
IMV
invasive mechanical ventilation
chemistry
COPD
chronic obstructive pulmonary disease
STROBE
Strengthening the Reporting of Observational Studies in Epidemiology
business
SD
standard deviation
Zdroj: The Journal of Allergy and Clinical Immunology
Journal of Allergy and Clinical Immunology
ISSN: 1097-6825
0091-6749
Popis: Background COVID-19 patients can develop a cytokine release syndrome that eventually leads to acute respiratory distress syndrome (ARDS) requiring invasive mechanical ventilation (IMV). Since interleukin-6 (IL-6) is a relevant cytokine in ARDS, the blockade of its receptor with Tocilizumab (TCZ) could reduce mortality and/or morbidity in severe COVID-19. Objective To determine whether baseline IL-6 serum levels can predict the need for IMV and the response to TCZ. Methods Retrospective observational study performed in hospitalized patients diagnosed of COVID-19. Clinical information and laboratory findings, including IL-6 levels, were collected approximately 3 and 9 days after admission to be matched with pre- and post-administration 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 (PaO2/FiO2) or mortality. Results One hundred and forty-six patients were studied, predominantly male (66%); median age was 63 years. Forty-four patients (30%) required IMV, and 58 patients (40%) received treatment with TCZ. IL-6 levels>30 pg/ml was the best predictor for IMV (OR:7.1; p30 pg/ml predicts IMV requirement in patients with COVID-19 and contributes to establish an adequate indication for TCZ administration.
Baseline IL-6 serum levels>30 pg/ml identify severe COVID-19 patients and should be used to guide the intervention with IL-6R inhibitors, aiming to improve their use in an uncertain and evolving therapeutic scenario.
Databáze: OpenAIRE
Externí odkaz: