Prompt Predicting of Early Clinical Deterioration of Moderate-to-Severe COVID-19 Patients: Usefulness of a Combined Score Using IL-6 in a Preliminary Study

Abstract

What is already known about this topic? Several clinical and laboratory factors have been reported to be associated with disease severity and death in patients with COVID-19. The time between hospital admission and clinical deterioration may be very short. What does the article add to our knowledge? We showed that elevated serum IL-6 levels at admission correlate with clinical worsening in COVID-19. We identified a 3-variable score (IL-6, C-reactive protein [CRP], SaO 2 /FiO 2) able to predict further clinical deterioration of patients with moderate-to-severe COVID-19 early in the course of admission. How does the study impact current management guidelines? IL-6, CRP, and SaO 2 /FiO 2 ratio, combined in our proposed score, could help clinicians to identify on admission those patients with COVID-19 who are at high risk for a further 3-day clinical deterioration. BACKGROUND: The early identification of patients at risk of clinical deterioration is of interest considering the timeline of COVID-19 after the onset of symptoms. OBJECTIVE: The aim of our study was to evaluate the usefulness of testing serum IL-6 and other serological and clinical biomarkers, to predict a short-term negative clinical course of patients with noncritical COVID-19. METHODS: A total of 208 patients with noncritical COVID-19 pneumonia at admission were consecutively enrolled. Clinical and laboratory findings obtained on admission were analyzed by using survival analysis and stepwise logistic regression for variable selection. Three-day worsening as outcome in a logistic model to generate a prognostic score was used. RESULTS: Clinical worsening occurred in 63 patients (16 [ died; 39 [ transferred to intensive care unit; 8 worsening of respiratory failure). Forty-five of them worsened within 3 days after admission. The risk of clinical worsening was progressively enhanced along with increasing quartiles of IL-6 levels. Multivariate analysis showed that IL-6 (P [ .005), C-reactive protein (CRP)

Charlson comorbidity index and a composite of poor outcomes in COVID-19 patients: A systematic review and meta-analysis

“…A total of 20 studies were included in the qualitative and quantitative synthesis ( Fig. 1 , Table 1 ) [ 2 , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] ]. One study which we included described an OR value.…”

Development and validation of a clinical risk score to predict the risk of SARS-CoV-2 infection from administrative data: a population-based cohort study from Italy

“…Third, the lack of specific data regarding the clinical outcome for the stratification of Covid-19 positive patients in terms of home isolation, hospitalization and admission in intensive care. Fourth, the lack of information on biologic markers potentially able to predict infection, and severity of its clinical manifestations, is another limitation of our study, as for example, according to the current literature, some laboratory hallmarks have been shown to predict infection, particularly in more severe cases [54]. Finally, our choice of accepting a 0.10 first type error, and of consequently reporting 90% confidence intervals, is justified by the exploratory nature of our study, but at the same time likely generate false positive signals, so limiting discriminant power of the score.…”

A gendered magnifying glass on COVID-19

“…Accordingly, IL-6 levels in patients requiring intensive care after SARS-CoV-2 infection increase over time and are higher in non-survivors than survivors [ 26 ]. IL-6 indeed plays a crucial role into the CRS and IL-6 levels together with C-reactive protein and SaO 2 /FiO 2 ratio would be predictors of rapid clinical deterioration in COVID-19 patients [ 81 ]. As a fact, tocilizumab is likely to be an effective drug for patients with severe COVID-19 [ 82 ] and anti-IL-6R strategy has been related with the restoration of NK cells killing machinery, profoundly affected in severely ill patients and also observed in macrophage activation syndrome [ 83 ].…”