key: cord-0825786-bj6q86hb
authors: Grifoni, Elisa; Valoriani, Alice; Cei, Francesco; Lamanna, Roberta; Gelli, Anna Maria Grazia; Ciambotti, Benedetta; Vannucchi, Vieri; Moroni, Federico; Pelagatti, Lorenzo; Tarquini, Roberto; Landini, Giancarlo; Vanni, Simone; Masotti, Luca
title: Interleukin-6 as prognosticator in patients with COVID-19: IL-6 and Covid-19
date: 2020-06-08
journal: J Infect
DOI: 10.1016/j.jinf.2020.06.008
sha: f89a89f5025a0f3512ebb171ec7bc21acf09b677
doc_id: 825786
cord_uid: bj6q86hb

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(2). Levels of IL-6 seem to be associated with inflammatory response, respiratory failure, needing for mechanical ventilation and/or intubation and mortality in COVID-19

patients (3, 4) . In a meta-analysis including nine studies (total 1426 patients) reporting on IL-6 and outcome in COVID-19, mean IL-6 levels were more than three times higher in patients with complicated COVID-19 compared with those with non complicated disease, and IL-6 levels were associated with mortality risk (4). However, whether IL-6 could be a better prognosticator than clinical and laboratory variables remains unclear.

Therefore, we tested the role of IL-6 as risk factor for negative outcome compared with other demographic and clinical variables or biomarkers collected at hospital admission.

Age over 60 years, presence of at least one co-morbidity among arterial hypertension, diabetes, cardiovascular disease, asthma, chronic lung disease, chronic kidney disease, liver disease, HIV infections, and malignancy for at least 6 months, lymphocyte count under 1.0 x 10 9 /L, lactate dehydrogenase (LDH) over 500 U/L, CALL score > 9 points (C=presence of co-morbidity, A=age over 60 years, L=lymphocyte count under 1.0 x 10 9 /L, L=LDH over 250 U/L or 500 U/L) (5), D-Dimer over 500 microg/L, and IL-6 over 25 pg/mL were the analyzed variables. Quantitative determination of IL-6 levels was performed by using an immunoenzymatic chemiluminescent assay (Access Immunoassay System, Beckman Coulter, USA, lowest limit of detection 0.5 pg/mL). (Figure 1) . The AUC for IL-6 as predictor of in-hospital mortality was 0.90 (95% CI 0.81-0.95), while it was 0.75 (95% CI 0.64-0.84) for IL-6 as predictor of progression to severe COVID-19.

In conclusion, in our COVID-19 population, IL-6 levels at hospital admission seem to be a good prognosticator for the combined endpoint progression to severe disease and/or in-hospital mortality, and it seems to be the best prognosticator for negative outcome. Therefore, our study supports the hypothesis that targeting the cytokine storm induced by SARS-CoV-2 by using anti-IL-6 drugs could be a valid therapeutic option, together with supportive care strategies, for improving outcomes in COVID-19 patients (6) .

The pathogenesis and treatment of the "Cytokine Storm" in COVID-19

Laboratory findings of COVID-19: a systematic review and metaanalysis

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

Elevated Interleukin-6 and Severe COVID-19: A Meta

Prediction for Progression Risk in Patients With COVID-19 Pneumonia: The CALL Score

SARS-CoV-2 and COVID-19: is interleukin-6 (IL-6) the 'culprit lesion' of ARDS onset? What is there besides Tocilizumab? SGP130Fc