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Cited by 1,161COVID-19 Clinical Research StudiesRespiratory Support and MechanismsSepsis Diagnosis and Treatment

Elevated levels of IL-6 and CRP predict the need for mechanical ventilation in COVID-19

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Herold, Tobias, Jurinovic, Vindi, Arnreich, Chiara, Lipworth, Brian J., Hellmuth, Johannes C., von Bergwelt-Baildon, Michael, Klein, Matthias, Weinberger, Tobias·2020·Journal of Allergy and Clinical Immunology
DOI 10.1016/j.jaci.2020.05.008PMC PMC7233239

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Abstract

Background Coronavirus disease 2019 (COVID-19) can manifest as a viral-induced hyperinflammation with multiorgan involvement. Such patients often experience rapid deterioration and need for mechanical ventilation. Currently, no prospectively validated biomarker of impending respiratory failure is available. Objective We aimed to identify and prospectively validate biomarkers that allow the identification of patients in need of impending mechanical ventilation. Methods Patients with COVID-19 who were hospitalized from February 29 to April 9, 2020, were analyzed for baseline clinical and laboratory findings at admission and during the disease. Data from 89 evaluable patients were available for the purpose of analysis comprising an initial evaluation cohort (n = 40) followed by a temporally separated validation cohort (n = 49). Results We identified markers of inflammation, lactate dehydrogenase, and creatinine as the variables most predictive of respiratory failure in the evaluation cohort. Maximal IL-6 level before intubation showed the strongest association with the need for mechanical ventilation, followed by maximal CRP level. The respective AUC values for IL-6 and CRP levels in the evaluation cohort were 0.97 and 0.86, and they were similar in the validation cohort (0.90 and 0.83, respectively). The calculated optimal cutoff values during the course of disease from the evaluation cohort (IL-6 level > 80 pg/mL and CRP level > 97 mg/L) both correctly classified 80% of patients in the validation cohort regarding their risk of respiratory failure. Conclusion The maximal level of IL-6, followed by CRP level, was highly predictive of the need for mechanical ventilation. This suggests the possibility of using IL-6 or CRP level to guide escalation of treatment in patients with COVID-19-related hyperinflammatory syndrome.

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  • Blood IL-6 level predicts the need for mechanical ventilation in COVID-19.

    “Among the elevated inflammatory mediators, the blood IL-6 level is highly correlated with the disease mortality (293, 338) and predicts the need for mechanical ventilation (339).”

    From IL-6 in inflammation, autoimmunity and cancer (2021) · cites this paper as [339]

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Cited by

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Authors
Herold, T., Jurinovic, V., Arnreich, C., Lipworth, B. J., Hellmuth, J. C., von Bergwelt-Baildon, M., Klein, M., & Weinberger, T.
Affiliations
  • Helmholtz Munich (DE)
  • University of Dundee (GB)
  • LMU Klinikum (DE)
Corresponding author
Herold, Tobias
ORCID
Venue
Journal of Allergy and Clinical Immunology
Publisher
Elsevier BV
Published
2020-07
Volume
146
Issue
1
Pages
128-136.e4
ISSN
0091-6749 (ISSN-L)
DOI
10.1016/j.jaci.2020.05.008
PMC
PMC7233239
OpenAlex
W3025160648
Cited by
1,161
References
3
Citations by year
2026: 39 · 2025: 51 · 2024: 84 · 2023: 157 · 2022: 247 · 2021: 337 · 2020: 245 · 2019: 1
FWCI
32.34
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Allergy and Clinical Immunology (publishedVersion)
  • medRxiv (acceptedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Discovery Research Portal (University of Dundee) (submittedVersion, other-oa)
  • Site cant be reached (submittedVersion, other-oa)
  • PuSH - Publication Server of Helmholtz Zentrum München (submittedVersion)
Funders
  • AstraZeneca
  • Sanofi
  • Teva Pharmaceutical Industries
  • F. Hoffmann-La Roche
  • Glenmark Pharmaceuticals
  • Ludwig-Maximilians-Universität München
Topics
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
Keywords
COVID-19 pandemic, interleukin-6, C-reactive protein, mechanical ventilation, respiratory failure, biomarkers, hyperinflammation, lactate dehydrogenase, creatinine, intubation prediction, cytokine storm
MeSH terms
Betacoronavirus, COVID-19, SARS-CoV-2, Adolescent, Adult, Aged, C-Reactive Protein, Female, Humans, Male, Middle Aged, Pneumonia, Viral, Respiration, Artificial, Respiratory Insufficiency, Biomarkers, Interleukin-6, Coronavirus Infections, Young Adult, Pandemics

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