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

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:147

Article

Maria Galvan-Roman, Jose¹  Rodriguez-Garcia, Sebastian C.²  Roy-Vallejo, Emilia¹  Marcos-Jimenez, Ana³  Sanchez-Alonso, Santiago³  Fernandez-Diaz, Carlos²  Alcaraz-Serna, Ana³  Mateu-Albero, Tamara³  Rodriguez-Cortes, Pablo¹  Sanchez-Cerrillo, Ildefonso³  Esparcia, Laura³  Martinez-Fleta, Pedro³  Lopez-Sanz, Celia³  Gabrie, Ligia³  del Campo Guerola, Luciana³  Suarez-Fernandez, Carmen¹  Ancochea, Julio⁴  Canabal, Alfonso⁵  Albert, Patricia⁵  Rodriguez-Serrano, Diego A.⁵  Mariano Aguilar, Juan⁶  del Arco, Carmen⁶  de los Santos, Ignacio¹  Garcia-Fraile, Lucio¹  de la Camara, Rafael⁷  Maria Serra, Jose⁸  Ramirez, Esther⁸  Alonso, Tamara⁴  Landete, Pedro⁴  Soriano, Joan B.⁴  Martin-Gayo, Enrique³  Fraile Torres, Arturo⁹  Zurita Cruz, Nelly Daniela⁹  Garcia-Vicuna, Rosario²  Cardenoso, Laura⁹  Sanchez-Madrid, Francisco^3,10  Alfranca, Arantzazu³  Munoz-Calleja, Cecilia³  Gonzalez-Alvaro, Isidoro² 

[1] Univ Autonoma Madrid, Hosp Univ Princesa, Inst Invest Sanitaria Princesa IIS IP, Internal Med Serv, Madrid, Spain

[2] Univ Autonoma Madrid, Hosp Univ Princesa, Inst Invest Sanitaria Princesa IIS IP, Rheumatol Serv, Madrid, Spain

[3] Univ Autonoma Madrid, Hosp Univ Princesa, Inst Invest Sanitaria Princesa IIS IP, Immunol Serv, Madrid, Spain

[4] Univ Autonoma Madrid, Hosp Univ Princesa, Inst Invest Sanitaria Princesa IIS IP, Serv Pneumol, Madrid, Spain

[5] Univ Autonoma Madrid, Hosp Univ Princesa, Inst Invest Sanitaria Princesa IIS IP, Intens Care Unit, Madrid, Spain

[6] Univ Autonoma Madrid, Hosp Univ Princesa, Inst Invest Sanitaria Princesa IIS IP, Emergency Serv, Madrid, Spain

[7] Univ Autonoma Madrid, Hosp Univ Princesa, Inst Invest Sanitaria Princesa IIS IP, Hematol Serv, Madrid, Spain

[8] Univ Autonoma Madrid, Hosp Univ Princesa, Inst Invest Sanitaria Princesa IIS IP, Hosp Pharm Serv, Madrid, Spain

[9] Univ Autonoma Madrid, Hosp Univ Princesa, Inst Invest Sanitaria Princesa IIS IP, Microbiol Serv, Madrid, Spain

[10] Inst Salud Carlos III ISCIII, Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain

关键词: COVID-19;    IL-6;    tocilizumab;    invasive mechanical ventilation;   

DOI  :  10.1016/j.jaci.2020.09.018

来源: Elsevier

【 摘 要 】

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.

【 授权许可】

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