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PLoS One . Combining IL-6 and SARS-CoV-2 RNAaemia-based risk stratification for fatal outcomes of COVID-19

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  • PLoS One . Combining IL-6 and SARS-CoV-2 RNAaemia-based risk stratification for fatal outcomes of COVID-19


    PLoS One


    . 2021 Aug 11;16(8):e0256022.
    doi: 10.1371/journal.pone.0256022. eCollection 2021.
    Combining IL-6 and SARS-CoV-2 RNAaemia-based risk stratification for fatal outcomes of COVID-19


    Ryo Saji 1 , Mototsugu Nishii 1 , Kazuya Sakai 1 , Kei Miyakawa 2 , Yutaro Yamaoka 2 3 , Tatsuma Ban 4 , Takeru Abe 5 , Yutaro Ohyama 1 , Kento Nakajima 1 , Taro Hiromi 1 , Reo Matsumura 1 , Naoya Suzuki 6 , Hayato Taniguchi 5 , Tsuyoshi Otsuka 6 , Yasufumi Oi 1 , Fumihiro Ogawa 1 , Munehito Uchiyama 1 , Kohei Takahashi 5 , Masayuki Iwashita 5 , Yayoi Kimura 7 , Satoshi Fujii 8 , Ryosuke Furuya 6 , Tomohiko Tamura 4 7 , Akihide Ryo 2 7 , Ichiro Takeuchi 1 5



    Affiliations

    Abstract

    Background: The coronavirus disease 2019 (COVID-19) pandemic rapidly increases the use of mechanical ventilation (MV). Such cases further require extracorporeal membrane oxygenation (ECMO) and have a high mortality.
    Objective: We aimed to identify prognostic biomarkers pathophysiologically reflecting future deterioration of COVID-19.
    Methods: Clinical, laboratory, and outcome data were collected from 102 patients with moderate to severe COVID-19. Interleukin (IL)-6 level and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA copy number in plasma were assessed with ELISA kit and quantitative PCR.
    Results: Twelve patients died or required ECMO owing to acute respiratory distress syndrome despite the use of MV. Among various variables, a ratio of oxygen saturation to fraction of inspired oxygen (SpO2/FiO2), IL-6, and SARS-CoV-2 RNA on admission before intubation were strongly predictive of fatal outcomes after the MV use. Moreover, among these variables, combining SpO2/FiO2, IL-6, and SARS-CoV-2 RNA showed the highest accuracy (area under the curve: 0.934). In patients with low SpO2/FiO2 (< 261), fatal event-rate after the MV use at the 30-day was significantly higher in patients with high IL-6 (> 49 pg/mL) and SARS-CoV-2 RNAaemia (> 1.5 copies/μL) compared to those with high IL-6 or RNAaemia or without high IL-6 and RNAaemia (88% vs. 22% or 8%, log-rank test P = 0.0097 or P < 0.0001, respectively).
    Conclusions: Combining SpO2/FiO2 with high IL-6 and SARS-CoV-2 RNAaemia which reflect hyperinflammation and viral overload allows accurately and before intubation identifying COVID-19 patients at high risk for ECMO use or in-hospital death despite the use of MV.


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