1. IL-6 serum levels predict severity and response to tocilizumab in COVID-19: An observational study.
- Author
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Galván-Román JM, Rodríguez-García SC, Roy-Vallejo E, Marcos-Jiménez A, Sánchez-Alonso S, Fernández-Díaz C, Alcaraz-Serna A, Mateu-Albero T, Rodríguez-Cortes P, Sánchez-Cerrillo I, Esparcia L, Martínez-Fleta P, López-Sanz C, Gabrie L, Del Campo Guerola L, Suárez-Fernández C, Ancochea J, Canabal A, Albert P, Rodríguez-Serrano DA, Aguilar JM, Del Arco C, de Los Santos I, García-Fraile L, de la Cámara R, Serra JM, Ramírez E, Alonso T, Landete P, Soriano JB, Martín-Gayo E, Fraile Torres A, Zurita Cruz ND, García-Vicuña R, Cardeñoso L, Sánchez-Madrid F, Alfranca A, Muñoz-Calleja C, and González-Álvaro I
- Subjects
- Adult, Aged, Aged, 80 and over, Disease-Free Survival, Female, Humans, Male, Middle Aged, Retrospective Studies, Survival Rate, Antibodies, Monoclonal, Humanized administration & dosage, COVID-19 blood, COVID-19 mortality, Cytokine Release Syndrome blood, Cytokine Release Syndrome drug therapy, Cytokine Release Syndrome mortality, Interleukin-6 blood, SARS-CoV-2, COVID-19 Drug Treatment
- 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., (Copyright © 2020 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
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