Interleukin-6 in Covid-19: A systematic review and meta-analysis
- PMID: 32845568
- PMCID: PMC7460877
- DOI: 10.1002/rmv.2141
Interleukin-6 in Covid-19: A systematic review and meta-analysis
Abstract
Coronaviruses may activate dysregulated host immune responses. As exploratory studies have suggested that interleukin-6 (IL-6) levels are elevated in cases of complicated Covid-19, we undertook a systematic review and meta-analysis to assess the evidence in this field. We systematically searched MEDLINE and EMBASE for studies investigating the immunological response in Covid-19; additional grey literature searches were undertaken. Study selection and data abstraction was undertaken independently by two authors. Meta-analysis was undertaken using random effects models to compute ratios of means with 95% confidence intervals (95%CIs). Eight published studies and two preprints (n = 1798) were eligible for inclusion. Meta-analysis of mean IL-6 concentrations demonstrated 2.9-fold higher levels in patients with complicated Covid-19 compared with patients with noncomplicated disease (six studies; n = 1302; 95%CI, 1.17-7.19; I2 = 100%). Consistent results were found in sensitivity analyses exclusively restricted to studies comparing patients requiring ICU admission vs no ICU admission (two studies; n = 540; ratio of means = 3.24; 95%CI, 2.54-4.14; P < .001; I2 = 87%). Nine of ten studies were assessed to have at least moderate risk of bias. In patients with Covid-19, IL-6 levels are significantly elevated and associated with adverse clinical outcomes. Inhibition of IL-6 may be a novel target for therapeutics for the management of dysregulated host responses in patients with Covid-19 and high-quality studies of intervention in this field are urgently required.
Keywords: Covid-19; IL6; SARS-CoV-2; Tocilizumab; cytokine storm; interleukin.
© 2020 John Wiley & Sons, Ltd.
Conflict of interest statement
Eric A. Coomes is a co‐investigator on a clinical trial of favipiravir chemoprophylaxis for COVID‐19 outbreaks in long‐term care homes. Hourmazd Haghbayan has no actual or potential conflict of interest to declare in relation to this study.
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- Paules CI, Marston HD, Fauci AS. Coronavirus infections‐more than just the common cold. JAMA. 2020;323:707. - PubMed
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