IL-6 serum levels predict severity and response to tocilizumab in COVID-19: An observational study.

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. We sought to determine whether baseline IL-6 serum levels can predict the need for IMV and the response to TCZ. 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. 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. 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. Copyright © 2020 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Citation

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, REINMUN-COVID Group. IL-6 serum levels predict severity and response to tocilizumab in COVID-19: An observational study. The Journal of allergy and clinical immunology. 2021 Jan;147(1):72-80.e8

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PMID: 33010257

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