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Deprecated: Implicit conversion from float 235.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 J+Allergy+Clin+Immunol 2021 ; 147 (1): 72-80.e8 Nephropedia Template TP
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IL-6 serum levels predict severity and response to tocilizumab in COVID-19: An observational study #MMPMID33010257
Galvan-Roman JM; Rodriguez-Garcia SC; Roy-Vallejo E; Marcos-Jimenez A; Sanchez-Alonso S; Fernandez-Diaz C; Alcaraz-Serna A; Mateu-Albero T; Rodriguez-Cortes P; Sanchez-Cerrillo I; Esparcia L; Martinez-Fleta P; Lopez-Sanz C; Gabrie L; Del Campo Guerola L; Suarez-Fernandez C; Ancochea J; Canabal A; Albert P; Rodriguez-Serrano DA; Aguilar JM; Del Arco C; de Los Santos I; Garcia-Fraile L; de la Camara R; Serra JM; Ramirez E; Alonso T; Landete P; Soriano JB; Martin-Gayo E; Fraile Torres A; Zurita Cruz ND; Garcia-Vicuna R; Cardenoso L; Sanchez-Madrid F; Alfranca A; Munoz-Calleja C; Gonzalez-Alvaro I
J Allergy Clin Immunol 2021[Jan]; 147 (1): 72-80.e8 PMID33010257show ga
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.