tetano
Editor, Senior Moderator
PLoS One
. 2023 Oct 27;18(10):e0293639.
doi: 10.1371/journal.pone.0293639. eCollection 2023. IL-6 serum level, ARDS, and AKI as risk factors for the COVID-19 infection's mortality in children
Idham Jaya Ganda[SUP] 1 2 [/SUP], Try Kartika Eka Putri[SUP] 3 [/SUP], Syarifuddin Rauf[SUP] 4 [/SUP], Amiruddin Laompo[SUP] 2 5 [/SUP], Ninny Meutia Pelupessy[SUP] 2 6 [/SUP], Sitti Aizah Lawang[SUP] 1 [/SUP], Nadirah Rasyid Ridha[SUP] 2 7 [/SUP], Bahrul Fikri[SUP] 2 8 [/SUP], Muhammad Nasrum Massi[SUP] 9 [/SUP]
Affiliations
Introduction: Dysregulated immune responses are developed in Coronavirus disease-2019 (COVID-19) and Interleukin-6 (IL-6) levels are reflecting the severity of the clinical presentation. This study aimed to analyze IL-6 serum level, Acute Respiratory Distress Syndrome (ARDS), and Acute Kidney Injury (AKI) as risk factors for mortality in children with COVID-19.
Methods: This prospective cohort study was conducted on children with COVID-19 infection confirmed by Real Time Polymerase Chain Reaction (RT-PCR) who were admitted to infection center at Dr. Wahidin Sudirohusodo Hospital from September 2021 to September 2022. Subjects were selected using the consecutive sampling method.
Results: A total of 2,060 COVID-19 RT-PCR tests were performed, and 1,065 children were confirmed positive. There were 291 cases that met the inclusion criteria, with 28.52 percent non-survives and 71.48% survives. The risk factors for mortality were IL-6, ARDS, AKI, Prothrombin Time / Activated Partial Thromboplastin Time (PT/aPTT), oxygen saturation, Absolut lymphocyte count (ALC), leukocytes, Length of Stay (LOS), and nutritional status (p<0.05). IL-6 levels increased in all patients (23.48-252.58 pq/ml). COVID-19 patients with AKI, ARDS, low oxygen saturation and thrombocytopenia had the highest levels of IL-6 (p 0.05). The IL-6 cut-off point was >80.97 pg/ml with 93% sensitivity and 90% specificity. Area Under Curve was 0.981 (95% CI), 0.960-1.000). A multivariate analysis showed IL-6 levels with OR 18.570 (95% CI 5.320-64.803), ARDS with Odds Ratio (OR) 10.177, (95% Confidence Interval (CI) 1.310-9.040), and AKI with OR 3.220 (95% CI 1.070-10.362). A combination of increased IL-6, ARDS, and AKI can predict a mortality probability as high as 98.3%.
Conclusion: IL-6, ARDS, and AKI are risk factors for mortality in children with COVID-19. IL-6 level was the highest mortality risk factor.
. 2023 Oct 27;18(10):e0293639.
doi: 10.1371/journal.pone.0293639. eCollection 2023. IL-6 serum level, ARDS, and AKI as risk factors for the COVID-19 infection's mortality in children
Idham Jaya Ganda[SUP] 1 2 [/SUP], Try Kartika Eka Putri[SUP] 3 [/SUP], Syarifuddin Rauf[SUP] 4 [/SUP], Amiruddin Laompo[SUP] 2 5 [/SUP], Ninny Meutia Pelupessy[SUP] 2 6 [/SUP], Sitti Aizah Lawang[SUP] 1 [/SUP], Nadirah Rasyid Ridha[SUP] 2 7 [/SUP], Bahrul Fikri[SUP] 2 8 [/SUP], Muhammad Nasrum Massi[SUP] 9 [/SUP]
Affiliations
- PMID: 37889917
- DOI: 10.1371/journal.pone.0293639
Introduction: Dysregulated immune responses are developed in Coronavirus disease-2019 (COVID-19) and Interleukin-6 (IL-6) levels are reflecting the severity of the clinical presentation. This study aimed to analyze IL-6 serum level, Acute Respiratory Distress Syndrome (ARDS), and Acute Kidney Injury (AKI) as risk factors for mortality in children with COVID-19.
Methods: This prospective cohort study was conducted on children with COVID-19 infection confirmed by Real Time Polymerase Chain Reaction (RT-PCR) who were admitted to infection center at Dr. Wahidin Sudirohusodo Hospital from September 2021 to September 2022. Subjects were selected using the consecutive sampling method.
Results: A total of 2,060 COVID-19 RT-PCR tests were performed, and 1,065 children were confirmed positive. There were 291 cases that met the inclusion criteria, with 28.52 percent non-survives and 71.48% survives. The risk factors for mortality were IL-6, ARDS, AKI, Prothrombin Time / Activated Partial Thromboplastin Time (PT/aPTT), oxygen saturation, Absolut lymphocyte count (ALC), leukocytes, Length of Stay (LOS), and nutritional status (p<0.05). IL-6 levels increased in all patients (23.48-252.58 pq/ml). COVID-19 patients with AKI, ARDS, low oxygen saturation and thrombocytopenia had the highest levels of IL-6 (p 0.05). The IL-6 cut-off point was >80.97 pg/ml with 93% sensitivity and 90% specificity. Area Under Curve was 0.981 (95% CI), 0.960-1.000). A multivariate analysis showed IL-6 levels with OR 18.570 (95% CI 5.320-64.803), ARDS with Odds Ratio (OR) 10.177, (95% Confidence Interval (CI) 1.310-9.040), and AKI with OR 3.220 (95% CI 1.070-10.362). A combination of increased IL-6, ARDS, and AKI can predict a mortality probability as high as 98.3%.
Conclusion: IL-6, ARDS, and AKI are risk factors for mortality in children with COVID-19. IL-6 level was the highest mortality risk factor.