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Observational Study
. 2024 Nov 28;14(1):29634.
doi: 10.1038/s41598-024-81028-3.

Prognostic significance of serum interleukin-6 in severe/critical COVID-19 patients treated with tocilizumab: a detailed observational study analysis

Panpan Liang #  1 , Yan Li #  2 , Li'e Meng  1 , Yuting Li  3 , Hailing Mai  4 , Tao Li  1 , Jiarui Ma  1 , Junhui Ma  1 , Jing Wang  3 , Bing Zhuan  5 , Wei Zhou  6
Affiliations
Observational Study

Prognostic significance of serum interleukin-6 in severe/critical COVID-19 patients treated with tocilizumab: a detailed observational study analysis

Panpan Liang et al. Sci Rep. .

Abstract

Baseline IL-6 levels have been found to be non-predictive of subsequent outcomes following tocilizumab treatment, highlighting the need for more reliable predictive markers. To address this, a retrospective analysis was conducted on the clinical profiles, diagnostic tests, and follow-up prognoses of 60 patients with severe or critical COVID-19, all of whom were identified as experiencing a cytokine storm and subsequently received tocilizumab treatment. Among the patients, the overall survival rate during follow-up was 80%, with further analysis revealing that advanced age was an independent risk factor for adverse outcomes. Following tocilizumab administration, a statistically significant increase in IL-6 and D-dimer levels was observed, while markers such as C-reactive protein (CRP), procalcitonin (PCT), and fibrinogen demonstrated reductions compared to pre-treatment values. Specifically, IL-6 levels initially surged briefly after tocilizumab intervention before gradually diminishing. To assess the prognostic utility of IL-6, the Receiver Operating Characteristic (ROC) curve was employed, which yielded an area under the curve (AUC) of 0.812, indicating strong predictive capability, with a sensitivity of 100% and a specificity of 53.49%. The optimal cut-off value for IL-6 was identified at 147.79 pg/mL. In conclusion, IL-6 levels tend to rise transiently following tocilizumab therapy, before gradually declining. These post-treatment IL-6 measurements may serve as a valuable biomarker for assessing prognosis in patients undergoing this treatment.

Keywords: COVID-19; IL6; Prognosis; Tocilizumab.

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Conflict of interest statement

Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Temporal changes in Interleukin-6 after tocilizumab administration. Panel A shows the changes in interleukin-6 over time; Panel B shows the changes in interleukin-6 levels over time between survivors and non-survivors.
Fig. 2
Fig. 2
The receiver operating characteristic curve of Interleukin-6 level and prognosis.
Fig. 3
Fig. 3
The analysis of Interleukin-6 level and prognosis after receiving tocilizumab treatment.
Fig. 4
Fig. 4
Temporal changes in C-reactive protein after tocilizumab administration. Panel A shows the changes of C-reactive protein over time; Panel B shows the changes in C-reactive protein over time between survivors and non-survivors.
Fig. 5
Fig. 5
Interleukin-6 in patients treated with 3 or 4 doses of tocilizumab.
Fig. 6
Fig. 6
Response of laboratory parameters to tocilizumab treatment. (A) Interleukin-6; (B) C-reactive protein; (C) Ferritin; (D) Procalcitonin; (E) Fibrinogen; (F) D-dimer.
Fig. 7
Fig. 7
The changes in fibrinogen and D-dimer in patients treated with 4 doses of tocilizumab.
See this image and copyright information in PMC

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