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. 2020 Jul 17:11:1093.
doi: 10.3389/fphar.2020.01093. eCollection 2020.

Dynamic Interleukin-6 Level Changes as a Prognostic Indicator in Patients With COVID-19

Zeming Liu  1 , Jinpeng Li  2 , Danyang Chen  1 , Rongfen Gao  3 , Wen Zeng  4 , Sichao Chen  1 , Yihui Huang  1 , Jianglong Huang  1 , Wei Long  1 , Man Li  1 , Liang Guo  1 , Xinghuan Wang  5 , Xiaohui Wu  6
Affiliations

Dynamic Interleukin-6 Level Changes as a Prognostic Indicator in Patients With COVID-19

Zeming Liu et al. Front Pharmacol. .

Abstract

Background: Interleukin-6 (IL-6), a proinflammatory cytokine, has been reported to be associated with disease severity and mortality in patients with coronavirus disease 2019 (COVID-19). Yet, dynamic changes in IL-6 levels and their prognostic value as an indicator of lung injury in COVID-19 patients have not been fully elucidated.

Objective: To validate whether IL-6 levels are associated with disease severity and mortality and to investigate whether dynamic changes in IL-6 levels might be a predictive factor for lung injury in COVID-19 patients.

Methods: This retrospective, single-center study included 728 adult COVID-19 patients and used data extracted from electronic medical records for analyses.

Results: The mortality rate was higher in the elevated IL-6 group than in the normal IL-6 group (0.16 vs 5%). Cox proportional hazards and logistic regression analyses for survival (adjusted hazard ratio, 10.39; 95% confidence interval [CI], 1.09-99.23; p = 0.042) and disease severity (adjusted odds ratio, 3.56; 95% CI, 2.06-6.19; p < 0.001) revealed similar trends. Curve-fitting analyses indicated that patient computed tomography (CT) scores peaked on days 22 and 24. An initial decline in IL-6 levels on day 16 was followed by resurgence to a peak, nearly in tandem with the CT scores.

Conclusion: Increased IL-6 level may be an independent risk factor for disease severity and in-hospital mortality and dynamic IL-6 changes may serve as a potential predictor for lung injury in Chinese COVID-19 patients. These findings may guide future treatment of COVID-19 patients.

Keywords: COVID-19; CT scores; SARS-CoV-2; infectious disease; interleukin-6; lung injury.

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Figures

Figure 1
Figure 1
Kaplan-Meier curves of IL-6 group stratification for survival. (A) Without adjustment; (B) Adjusted for age, the history of cardiovascular disease, lymphocyte count, D-dimer, and lactate dehydrogenase.
Figure 2
Figure 2
Cumulative hazards of death are presented. (A) Without adjustment; (B) Adjusted for age, history of cardiovascular disease, lymphocyte count, D-dimer, and lactate dehydrogenase.
Figure 3
Figure 3
(A) ROC curve assessed the predictive capability of elevated IL-6 for death; (B) ROC curve assessed the predictive capability of elevated IL-6 for disease severity; (C) ROC curve assessed the predictive capability of elevated IL-6 for CT scores.
Figure 4
Figure 4
Curve fitting analyses with CT scores for all COVID-19 patients (A, C, E); IL-6 elevated group (IL>7 pg/ml) versus IL-6 elevated group (IL≤ 7 pg/ml) (B, D, F).
Figure 5
Figure 5
Comparison of CT scores trend and IL-6 levels over time with curve fitting analyses. (A) All the COVID-19 patients; (B) Patients with elevated IL-6.
See this image and copyright information in PMC

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