tetano
Editor, Senior Moderator
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[SUP] 1 [/SUP], Mototsugu Nishii[SUP] 1 [/SUP], Kazuya Sakai[SUP] 1 [/SUP], Kei Miyakawa[SUP] 2 [/SUP], Yutaro Yamaoka[SUP] 2 3 [/SUP], Tatsuma Ban[SUP] 4 [/SUP], Takeru Abe[SUP] 5 [/SUP], Yutaro Ohyama[SUP] 1 [/SUP], Kento Nakajima[SUP] 1 [/SUP], Taro Hiromi[SUP] 1 [/SUP], Reo Matsumura[SUP] 1 [/SUP], Naoya Suzuki[SUP] 6 [/SUP], Hayato Taniguchi[SUP] 5 [/SUP], Tsuyoshi Otsuka[SUP] 6 [/SUP], Yasufumi Oi[SUP] 1 [/SUP], Fumihiro Ogawa[SUP] 1 [/SUP], Munehito Uchiyama[SUP] 1 [/SUP], Kohei Takahashi[SUP] 5 [/SUP], Masayuki Iwashita[SUP] 5 [/SUP], Yayoi Kimura[SUP] 7 [/SUP], Satoshi Fujii[SUP] 8 [/SUP], Ryosuke Furuya[SUP] 6 [/SUP], Tomohiko Tamura[SUP] 4 7 [/SUP], Akihide Ryo[SUP] 2 7 [/SUP], Ichiro Takeuchi[SUP] 1 5 [/SUP]
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.
. 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[SUP] 1 [/SUP], Mototsugu Nishii[SUP] 1 [/SUP], Kazuya Sakai[SUP] 1 [/SUP], Kei Miyakawa[SUP] 2 [/SUP], Yutaro Yamaoka[SUP] 2 3 [/SUP], Tatsuma Ban[SUP] 4 [/SUP], Takeru Abe[SUP] 5 [/SUP], Yutaro Ohyama[SUP] 1 [/SUP], Kento Nakajima[SUP] 1 [/SUP], Taro Hiromi[SUP] 1 [/SUP], Reo Matsumura[SUP] 1 [/SUP], Naoya Suzuki[SUP] 6 [/SUP], Hayato Taniguchi[SUP] 5 [/SUP], Tsuyoshi Otsuka[SUP] 6 [/SUP], Yasufumi Oi[SUP] 1 [/SUP], Fumihiro Ogawa[SUP] 1 [/SUP], Munehito Uchiyama[SUP] 1 [/SUP], Kohei Takahashi[SUP] 5 [/SUP], Masayuki Iwashita[SUP] 5 [/SUP], Yayoi Kimura[SUP] 7 [/SUP], Satoshi Fujii[SUP] 8 [/SUP], Ryosuke Furuya[SUP] 6 [/SUP], Tomohiko Tamura[SUP] 4 7 [/SUP], Akihide Ryo[SUP] 2 7 [/SUP], Ichiro Takeuchi[SUP] 1 5 [/SUP]
Affiliations
- PMID: 34379684
- DOI: 10.1371/journal.pone.0256022
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.