Level of IL-6 predicts respiratory failure in hospitalized symptomatic COVID-19 patients

The pandemic Coronavirus-disease 19 (COVID-19) is characterized by a heterogeneous clinical course. While most patients experience only mild symptoms, a relevant proportion develop severe disease progression with increasing hypoxia up to acute respiratory distress syndrome.

The substantial number of patients with severe disease have strained intensive care capacities to an unprecedented level.

In this way, owing to the highly variable course and lack of reliable predictors for deterioration, authors aimed to identify variables that allow the prediction of patients with a high risk of respiratory failure and need of mechanical ventilation. 40 patients with Polymerase Chain Reaction (PCR) proven symptomatic COVID-19 infection hospitalized from 29th February to 27th March 2020, were analyzed for baseline clinical and laboratory findings. Patients requiring mechanical ventilation 13/40 (32.5%) did not differ in age, comorbidities, radiological findings, respiratory rate or qSofa score.

However, authors found elevated interleukin-6 (IL-6) was strongly associated with the need for mechanical ventilation. In addition, the maximal IL-6 level (cutoff 80 pg/ml) for each patient during disease predicted respiratory failure with high accuracy. In this way, the risk of respiratory failure for patients with IL-6 levels of ≥80 pg/ml was 22 times higher compared to patients with lower IL-6 levels.

In the current situation with overwhelmed intensive care units and overcrowded emergency rooms, correct triage of patients in need of intensive care is crucial, and this study shows that IL-6 is an effective marker that might be able to predict upcoming respiratory failure with high accuracy and help physicians correctly allocate patients at an early stage.

Link to the paper: https://doi.org/10.1101/2020.04.01.20047381

Editorial Disclaimer: information published during the 2020 COVID-19 pandemic may be updated frequently to reflect the dynamic nature of current understanding.

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