Tags

Type your tag names separated by a space and hit enter

IL-6 serum levels predict severity and response to tocilizumab in COVID-19: An observational study.
J Allergy Clin Immunol. 2021 01; 147(1):72-80.e8.JA

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.

Authors+Show Affiliations

Internal Medicine Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Rheumatology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Internal Medicine Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Rheumatology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Internal Medicine Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Internal Medicine Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Pneumology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Intensive Care Unit, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Intensive Care Unit, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Intensive Care Unit, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Emergency Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Emergency Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Internal Medicine Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Internal Medicine Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Hematology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Hospital Pharmacy Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Hospital Pharmacy Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Pneumology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Pneumology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Pneumology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Microbiology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Microbiology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Rheumatology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Microbiology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain; Centro de Investigación Biomédica en Red - Enfermedades Cardiovasculares (CIBER CV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Immunology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain.Rheumatology Service, Hospital Universitario de la Princesa, Universidad Autónoma Madrid, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain. Electronic address: isidoro.ga@ser.es.No affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33010257

Citation

Galván-Román, José María, et al. "IL-6 Serum Levels Predict Severity and Response to Tocilizumab in COVID-19: an Observational Study." The Journal of Allergy and Clinical Immunology, vol. 147, no. 1, 2021, pp. 72-80.e8.
Galván-Román JM, Rodríguez-García SC, Roy-Vallejo E, et al. IL-6 serum levels predict severity and response to tocilizumab in COVID-19: An observational study. J Allergy Clin Immunol. 2021;147(1):72-80.e8.
Galván-Román, J. M., Rodríguez-García, S. C., 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., ... González-Álvaro, I. (2021). IL-6 serum levels predict severity and response to tocilizumab in COVID-19: An observational study. The Journal of Allergy and Clinical Immunology, 147(1), 72-e8. https://doi.org/10.1016/j.jaci.2020.09.018
Galván-Román JM, et al. IL-6 Serum Levels Predict Severity and Response to Tocilizumab in COVID-19: an Observational Study. J Allergy Clin Immunol. 2021;147(1):72-80.e8. PubMed PMID: 33010257.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - IL-6 serum levels predict severity and response to tocilizumab in COVID-19: An observational study. AU - Galván-Román,José María, AU - Rodríguez-García,Sebastián C, AU - Roy-Vallejo,Emilia, AU - Marcos-Jiménez,Ana, AU - Sánchez-Alonso,Santiago, AU - Fernández-Díaz,Carlos, AU - Alcaraz-Serna,Ana, AU - Mateu-Albero,Tamara, AU - Rodríguez-Cortes,Pablo, AU - Sánchez-Cerrillo,Ildefonso, AU - Esparcia,Laura, AU - Martínez-Fleta,Pedro, AU - López-Sanz,Celia, AU - Gabrie,Ligia, AU - Del Campo Guerola,Luciana, AU - Suárez-Fernández,Carmen, AU - Ancochea,Julio, AU - Canabal,Alfonso, AU - Albert,Patricia, AU - Rodríguez-Serrano,Diego A, AU - Aguilar,Juan Mariano, AU - Del Arco,Carmen, AU - de Los Santos,Ignacio, AU - García-Fraile,Lucio, AU - de la Cámara,Rafael, AU - Serra,José María, AU - Ramírez,Esther, AU - Alonso,Tamara, AU - Landete,Pedro, AU - Soriano,Joan B, AU - Martín-Gayo,Enrique, AU - Fraile Torres,Arturo, AU - Zurita Cruz,Nelly Daniela, AU - García-Vicuña,Rosario, AU - Cardeñoso,Laura, AU - Sánchez-Madrid,Francisco, AU - Alfranca,Arantzazu, AU - Muñoz-Calleja,Cecilia, AU - González-Álvaro,Isidoro, AU - ,, Y1 - 2020/09/30/ PY - 2020/05/29/received PY - 2020/09/07/revised PY - 2020/09/17/accepted PY - 2020/10/4/pubmed PY - 2021/1/16/medline PY - 2020/10/3/entrez KW - COVID-19 KW - IL-6 KW - invasive mechanical ventilation KW - tocilizumab SP - 72 EP - 80.e8 JF - The Journal of allergy and clinical immunology JO - J Allergy Clin Immunol VL - 147 IS - 1 N2 - 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. SN - 1097-6825 UR - https://www.unboundmedicine.com/medline/citation/33010257/IL_6_serum_levels_predict_severity_and_response_to_tocilizumab_in_COVID_19:_An_observational_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0091-6749(20)31329-4 DB - PRIME DP - Unbound Medicine ER -