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Rodríguez-García, Sebastián C.; Sánchez-Alonso, Santiago; Alcaraz-Serna, Ana; Rodríguez-Cortes, Pablo; Sánchez-Cerrillo, Ildefonso; Esparcia, Laura; Martínez-Fleta, Pedro; López-Sanz, Celia; del Campo Guerola, Luciana; Suárez-Fernández, Carmen; Ancochea, Julio; Albert, Patricia; Rodríguez-Serrano, Diego A.; del Arco, Carmen; García-Fraile, Lucio; Serra, José María; Ramírez, Esther; Alonso, Tamara; Landete, Pedro; Martín-Gayo, Enrique; Fraile Torres, Arturo; Zurita Cruz, Nelly Daniela; Cardeñoso, Laura; Alfranca, Arantzazu; González-Álvaro, Isidoro; Javier de la Cuerda Llorente, Francisco; Santiago, Cristina; Junquera, Manuel; Val, Francisco Javier; Caño, Marta; López, Isabel; von Wernitz, Andrés; Guerra, Iñigo; Sorando, Jorge; Chao, Lydia; Rodríguez, Pedro; Sampedro, Miguel; Prada, Jorge; Caldas, María; Camara, Rafael de la; Aguadol, Beatriz; Morell, Alberto; Zurriaga, Amparo Ibáñez; Abanades, María Pérez; Aranda, Tomás Gallego; Ruiz, María; Nieto, Concepción Martínez; Aspa, Javier; Marcos-Jiménez, Ana; Alcaraz-Serna, Ana; Mateu-Albero, Tamara; Sánchez-Cerrillo, Ildefonso; Esparcia, Laura; Martínez-Fleta, Pedro; López-Sanz, Celia; Gabrie, Ligia; Guerola, Luciana del Campo; Fernández, Elena; Calzada, Ma José; Albert, Patricia; Rodríguez-Serrano, Diego A.; Iglesias, Judit; Suarez, Fernando; Sánchez, Juan Antonio; Abad, Beatriz; Santos, Ignacio de los; Galván-Román, José María; Sanz, Jesus; Sanchez, Eduardo; Casado, Pedro; Curbelo, Jose; Bautista, Azucena; Giménez, Nuria Ruiz; Parra, Pedro; Barrios, Ana; Real de Asua, Diego; Sanchez, Beatriz; Saez, Carmen; Navas, Desiré; Domingo, Laura Cardeñoso; Torresano, María del Carmen Cuevas; García, Diego Domingo; Blanco, Alicia García; Semiglia Chong, María Auxiliadora; Cobos, Ainhoa Gutiérrez; Zurita Cruz, Nelly Daniela; Perpén, Antonio Fernádez; Ancochea, Julio; Castillo, Elena García; García, Patricia García; Castañeda, Santos; García-Vicuña, Rosario; González-Álvaro, Isidoro; Rodríguez-García, Sebastián; Cubas, Irene Llorente; Tomero, Eva G.; Castañeda, Noelia García; Ortiz, Ana Ma; Uriarte, Miren; Montes, Nuria
Journal of allergy and clinical immunology, 01/2021, Letnik: 147, Številka: 1Journal Article
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. We sought to determine whether baseline IL-6 serum levels can predict the need for IMV and the response to TCZ. 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. 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. 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.
