J. Galván-Román, S. Rodriguez-García, E. Roy-Vallejo, A. Marcos-Jiménez, S. Sánchez-Alonso, C. Fernández-Díaz, A. Alcaraz-Serna, T. Mateu-Albero, P. Rodríguez-Cortés, I. Sánchez-Cerrillo, L. Esparcia, P. Martínez-Fleta, C. López-Sanz, L. Gabrie, L. del Campo Guerola, C. Suárez-Fernández, J. Ancochea, A. Canabal, P. Albert, D. Rodríguez-Serrano, J. Aguilar, C. del Arco, I. de Los Santos, L. García-Fraile, R. de la Cámara, J. Serra, E. Ramírez, Tamara Alonso, P. Landete, J. B. Soriano, E. Martín-Gayo, A. F. Fraile Torres, N. D. Zurita Cruz, R. García-Vicuña, L. Cardeñoso, F. Sánchez‐Madrid, A. Alfranca, C. Muñoz‐Calleja, I. González-Álvaro, T. Alvarado, P. Martínez, Francisco Javier de la Cuerda Llorente, C. Arco, N. Villalba, M. Negro, E. Contreras, Ana Margarita López Rodríguez del Rey, C. Santiago, M. Junquera, R. Caminero, F. Val, S. González, M. Cano, Isabel López, Andrés von Wernitz, Bárbara Retana, Iñigo Guerra, Jorge Sorando, Lydia Chao, M. J. Cárdenas, V. Espiga, P. Chicharro, Pedro Rodríguez, Iñigo Hernando Alday, M. Sampedro, J. Prada, E. Aldama, Y. Real, M. Caldas, S. Casabona, Aitor Lanas-Gimeno, R. Cámara, A. F. Alvárez, Beatriz Aguadol, A. Morell, A. Zurriaga, M. Abanades, S. García, T. G. Aranda, María Ruiz, C. Nieto, J. Aspa, Luciana del Campo Guerola, Elena Fernández, Marelys Calzada, R. Tejedor, J. Iglesias, F. Suarez, Juan Antonio Sánchez, Beatriz Abad, C. Suárez, Ignacio de los Santos, J. Galván-Román, Emilia Roy, J. Sanz, Eduardo Sanchez, F. Moldenhauer, P. Casado, J. Curbelo, Á. Gutiérrez, Azucena Bautista, N. R. Giménez, Angelica Fernandez, P. Parra, Berta Moyano, A. Barrios, D. Real de Asúa, B. Sánchez, C. Sáez, M. Ciudad, Desiree Navas, L. Domingo, María del Carmen Cuevas Torresano, Diego Domingo García, T. Cavero, A. Blanco, Alexandra Martín Ramírez, María Auxiliadora Semiglia Chong, Ainhoa Gutiérrez Cobos, A. F. Fraile Torres, Carmen Sánchez-González, Antonio Fernádez Perpén, Carolina Díaz Pérez, Joan Soriano, C. Cisneros, Elena García Castillo, F. J. García Pérez, R. Girón, C. Marcos, Enrique Zamora, Patricia García García, S. Castañeda, S. Rodriguez-García, Irene Llorente Cubas, E. Tomero, N. G. Castañeda, A. M. Ortiz, C. Valero, M. Uriarte, N. Montes
Journal of Allergy and Clinical Immunology, 2020
Background COVID-19 patients can develop a cytokine release syndrome that eventually leads to acute respiratory distress syndrome (ARDS) requiring invasive mechanical ventilation (IMV). Since interleukin-6 (IL-6) is a relevant cytokine in ARDS, the blockade of its receptor with Tocilizumab (TCZ) could reduce mortality and/or morbidity in severe COVID-19. Objective To determine whether baseline IL-6 serum levels can predict the need for IMV and the response to TCZ. Methods Retrospective observational study performed in hospitalized patients diagnosed of COVID-19. Clinical information and laboratory findings, including IL-6 levels, were collected approximately 3 and 9 days after admission to be matched with pre- and post-administration 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 (PaO2/FiO2) or mortality. Results One hundred and forty-six patients were studied, predominantly male (66%); median age was 63 years. Forty-four patients (30%) required IMV, and 58 patients (40%) received treatment with TCZ. IL-6 levels>30 pg/ml was the best predictor for IMV (OR:7.1; p<0.001). Early administration of TCZ was associated with improvement of oxygenation (PaO2/FiO2) in patients with high IL-6 (p=0.048). Patients with high IL-6 not treated with TCZ showed high mortality (HR: 4.6; p=0.003), as well as those with low IL-6 treated with TCZ (HR: 3.6; p=0.016). No relevant serious adverse events were observed in TCZ-treated patients. Conclusion Baseline IL-6>30 pg/ml predicts IMV requirement in patients with COVID-19 and contributes to establish an adequate indication for TCZ administration.
Cited by 44 publications.
Field of study: Medicine