Elevated levels of IL-6 and CRP predict the need for mechanical ventilation in COVID-19

By T. Herold, V. Jurinovic, Chiara Arnreich, B. Lipworth, J. Hellmuth, Michael von Bergwelt-Baildon, M. Klein, T. Weinberger. Journal of Allergy and Clinical Immunology, 2020

927 citations recorded by the source corpus.

Background Coronavirus disease 2019 (COVID-19) can manifest as a viral-induced hyperinflammation with multiorgan involvement. Such patients often experience rapid deterioration and need for mechanical ventilation. Currently, no prospectively validated biomarker of impending respiratory failure is available. Objective We aimed to identify and prospectively validate biomarkers that allow the identification of patients in need of impending mechanical ventilation. Methods Patients with COVID-19 who were hospitalized from February 29 to April 9, 2020, were analyzed for baseline clinical and laboratory findings at admission and during the disease. Data from 89 evaluable patients were available for the purpose of analysis comprising an initial evaluation cohort (n = 40) followed by a temporally separated validation cohort (n = 49). Results We identified markers of inflammation, lactate dehydrogenase, and creatinine as the variables most predictive of respiratory failure in the evaluation cohort. Maximal IL-6 level before intubation showed the strongest association with the need for mechanical ventilation, followed by maximal CRP level. The respective AUC values for IL-6 and CRP levels in the evaluation cohort were 0.97 and 0.86, and they were similar in the validation cohort (0.90 and 0.83, respectively). The calculated optimal cutoff values during the course of disease from the evaluation cohort (IL-6 level > 80 pg/mL and CRP level > 97 mg/L) both correctly classified 80% of patients in the validation cohort regarding their risk of respiratory failure. Conclusion The maximal level of IL-6, followed by CRP level, was highly predictive of the need for mechanical ventilation. This suggests the possibility of using IL-6 or CRP level to guide escalation of treatment in patients with COVID-19–related hyperinflammatory syndrome.

Subfields: Infectious Diseases, Neurology, Pulmonary and Respiratory Medicine

View Paper: https://www.semanticscholar.org/paper/fa9f3e6a9028c4f0c33fa9bc08f03edb3968dfb7

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In Infectious Diseases

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Citations in the corpus

Immunology of COVID-19: Current State of the Science (2020, neutral): “While there are reports that levels of IL-6 at first assessmentmight predict respiratory failure (Herold et al., 2020), other publications with longitudinal analysesdemonstrated that IL-6 increases fairly late during the disease’s course, consequently compromising its prognostic value at earlier…”
Phenotype and kinetics of SARS-CoV-2-specific T cells in COVID-19 patients with acute respiratory distress syndrome (2020, background): “Elevated levels of IL-6 in patient plasma have been correlated to respiratory failure in COVID-19 patients (18).”
The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings (2020, background): “Muscle pain and elevated creatinine kinase have been reported as relatively common manifestations of SARSCoV-2 infection (Chen et al., 2020; Guan et al., 2020; Huang et al., 2020) and there are case reports of rhabdomyolysis (Rivas-Garcia et al., 2020).”