Higher levels of IL-6 early after tocilizumab distinguish survivors from nonsurvivors in COVID-19 pneumonia: A possible indication for deeper targeting of IL-6
Higher levels of IL-6 early after tocilizumab distinguish survivors from nonsurvivors in COVID-19 pneumonia: A possible indication for deeper targeting of IL-6
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DOI：
10.1002/jmv.26149
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发表时间：
2020-07-22
影响因子：
12.7
通讯作者：
De Vita, Salvatore
中科院分区：
文献类型：
--
作者：
Quartuccio, Luca;Sonaglia, Arianna;De Vita, Salvatore
由严重急性呼吸综合征冠状病毒2衍生的最严重的COVID-19会引起细胞因子释放风暴，并与更糟糕的结果相关。在COVID-19患者中，白细胞介素-6 （IL-6）水平显著升高。阻断IL-6可初步改善这种高炎症状态。目前尚不清楚哪些患者需要更高剂量的托珠单抗来摆脱细胞因子风暴。材料与方法选取24例新型冠状病毒肺炎患者。所有患者均静脉注射托珠单抗8 mg/kg，注射前24 ~ 48小时和注射后12 ~ 48小时检测血清IL-6。对幸存者和非幸存者进行比较。结果18例患者出院，6例患者死亡，两组在基线时无临床或实验室差异。IL-6在基线时没有差异（P = 0.41），而托珠单抗治疗后24至48小时，非幸存者血清IL-6水平显著高于幸存者（2398.5 [430.5-9372]vs 290.5 [58.5-1305.5] pg/mL,P = 0.022）。托珠单抗后血清IL-6显示出区分幸存者和非幸存者的良好预测能力（曲线下面积，0.815；95%置信区间，0.63-0.99,P = 0.02）。结论托珠单抗治疗后早期反复检测血清IL-6水平可区分非存活者和存活者，支持选择深度靶向IL-6治疗COVID-19肺炎。
Introduction The most serious COVID-19 deriving from severe acute respiratory syndrome coronavirus 2 causes a cytokine release storm and it is associated with worse outcomes. In COVID-19 patients, interleukin-6 (IL-6) levels are significantly elevated. Blocking IL-6 preliminarily resulted in the improvement of this hyperinflammatory state. It is unknown which patients could require higher doses of tocilizumab to get out of the cytokine storm. Materials and Methods Twenty-four patients affected by COVID-19 pneumonia were included. All the patients underwent tocilizumab 8 mg/kg intravenously and were tested for serum IL-6 24 to 48 hours before and 12 to 48 hours after tocilizumab infusion. Comparisons between survivors and nonsurvivors were performed. Results Eighteen patients were discharged, while six patients died, with no clinical or laboratory differences between the two groups at baseline. IL-6 was not different at baseline (P = .41), while 24 to 48 hours post-tocilizumab IL-6 serum levels were significantly higher in nonsurvivors than in survivors (2398.5 [430.5-9372] vs 290.5 [58.5-1305.5] pg/mL,P = .022). Serum IL-6 post-tocilizumab showed a good predictive ability to discriminate survivors from nonsurvivors (area under the curve, 0.815; 95% confidence interval, 0.63-0.99,P = .02). Conclusion Repeated measurement of the serum level of IL-6 early after tocilizumab may distinguish nonsurvivors from survivors and support the choice of deeper targeting IL-6 in COVID-19 pneumonia.