Elevated levels of IL-6 and CRP predict the need for mechanical ventilation in COVID-19
Elevated levels of IL-6 and CRP predict the need for mechanical ventilation in COVID-19
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DOI：
10.1016/j.jaci.2020.05.008
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发表时间：
2020-07-01
影响因子：
14.2
通讯作者：
Weinberger, Tobias
中科院分区：
文献类型：
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作者：
Herold, Tobias;Jurinovic, Vindi;Weinberger, Tobias
背景：2019冠状病毒病（COVID-19）可以表现为病毒诱导的多器官受累的过度炎症。这类患者通常会经历快速恶化，需要机械通气。目的：我们的目的是确定和前瞻性验证生物标志物，允许识别需要紧急机械通气的患者。方法：对2020年2月29日至4月9日住院的COVID-19患者在入院时和疾病期间的基线临床和实验室检查结果进行分析。来自89名可评估患者的数据可用于分析的目的，包括初始评估队列（n = 40），随后是时间上分开的验证队列（n = 49）。结果：我们确定了炎症标志物，乳酸脱氢酶和肌酐作为评估队列中最能预测呼吸衰竭的变量。插管前最大IL-6水平与机械通气需求的相关性最强，其次是最大CRP水平。评价队列中IL-6和CRP水平的AUC值分别为0.97和0.86，验证队列中的AUC值相似（分别为0.90和0.83）。在评估队列的疾病过程中计算的最佳截止值（IL-6水平> 80 pg/mL和CRP水平> 97 mg/L）都正确分类80%的患者在验证队列中关于他们的呼吸衰竭的风险。结论：IL-6的最大水平，其次是CRP水平，是高度预测需要机械通气。这表明有可能使用IL-6或CRP水平来指导COVID-19相关炎症过度综合征患者的治疗升级。
Background: Coronavirus disease 2019 (COVID-19) can manifest as a viral-induced hyperinflammation with multiorgan involvement. Such patients often experience rapid deterioration and need for mechanical ventilation. Currently, no prospectively validated biomarker of impending respiratory failure is available.Objective: We aimed to identify and prospectively validate biomarkers that allow the identification of patients in need of impending mechanical ventilation.Methods: Patients with COVID-19 who were hospitalized from February 29 to April 9, 2020, were analyzed for baseline clinical and laboratory findings at admission and during the disease. Data from 89 evaluable patients were available for the purpose of analysis comprising an initial evaluation cohort (n = 40) followed by a temporally separated validation cohort (n = 49).Results: We identified markers of inflammation, lactate dehydrogenase, and creatinine as the variables most predictive of respiratory failure in the evaluation cohort. Maximal IL-6 level before intubation showed the strongest association with the need for mechanical ventilation, followed by maximal CRP level. The respective AUC values for IL-6 and CRP levels in the evaluation cohort were 0.97 and 0.86, and they were similar in the validation cohort (0.90 and 0.83, respectively). The calculated optimal cutoff values during the course of disease from the evaluation cohort (IL-6 level > 80 pg/mL and CRP level > 97 mg/L) both correctly classified 80% of patients in the validation cohort regarding their risk of respiratory failure.Conclusion: The maximal level of IL-6, followed by CRP level, was highly predictive of the need for mechanical ventilation. This suggests the possibility of using IL-6 or CRP level to guide escalation of treatment in patients with COVID-19-related hyperinflammatory syndrome.