Open AccessCombining IL-6 and SARS-CoV-2 RNAaemia-based risk stratification for fatal outcomes of COVID-19
Author(s) -
Ryo Saji,
Mototsugu Nishii,
Kazuya Sakai,
Kei Miyakawa,
Yutaro Yamaoka,
Tatsuma Ban,
Takeru Abe,
Yutaro Ohyama,
Kento Nakajima,
Taro Hiromi,
Reo Matsumura,
Naoya Suzuki,
Hayato Taniguchi,
Tsuyoshi Otsuka,
Yasufumi Oi,
Fumihiro Ogawa,
Mitsuaki Uchiyama,
Kohei Takahashi,
Masayuki Iwashita,
Yayoi Kimura,
Satoshi Fujii,
Ryosuke Furuya,
Tomohide Tamura,
Akihide Ryo,
Ichiro Takeuchi
Publication year - 2021
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0256022
Subject(s) - medicine , extracorporeal membrane oxygenation , covid-19 , fraction of inspired oxygen , intubation , ards , mechanical ventilation , coronavirus , severe acute respiratory syndrome , anesthesia , lung , disease , infectious disease (medical specialty)
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.