白细胞介素-6水平在预测COVID严重程度中的作用:单中心体验

IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL
AnshuGupta Devra, Gurleen Gill
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This study was conducted on 100 reverse transcription–polymerase chain reaction confirmed COVID-positive patients. The patients were then categorized into mild, moderate, and severe COVID at the time of admission according to the criteria laid down by symptoms and SpO2 levels at room air as defined by ICMR COVID guidelines by the Ministry of Health and Family Welfare[1] (MOHFW), Government of India, revised on January 14, 2022 – Mild disease – Upper respiratory tract symptoms and/or fever without shortness of breath or hypoxia Moderate disease – Any one of: Respiratory rate ≥24/min, SpO2: 90% to ≤93% on room air Severe disease – Any one of: Respiratory rate >30/min, SpO2 <90% on room air. For ease of comparison and to effectively evaluate high-risk patients, mild and moderate categories were clubbed together into nonsevere as they can be managed in L-2 facility. However, those falling in the severe category require L-3 facilities with advanced infrastructure and ICU facilities and are, therefore, categorized separately. Levels of IL-6 and NLR were compared between the two groups. NLR was derived by dividing the percentage of neutrophils to the percentage of lymphocytes after calculating differential leukocyte count taking the normal upper limit of NLR as 3.5, as identified by Forget et al.[2] for the adult nongeriatric population in good health.[2] The mean value of NLR in mild, moderate, and severe categories was 3.9, 3.1, and 6.7, respectively. On combining mild and moderate categories as nonsevere, the mean values of NLR obtained were 3.7, almost half of the NLR mean values observed in the severe category, i.e., 6.7. On applying the analysis of variance (ANOVA) t-test, a significant statistical correlation (P = 0.016) of NLR was found with clinical severity. 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On applying ANOVA t-test for the strength of significance between groups, no significant association was found between IL-6 levels and clinical severity (P = 0.510).Table 1: Coronavirus disease 2019 severity and interleukin-6 levelsWith respect to IL-6, on comparing our results with other studies [Table 2], one Indian study undertaken by Bhandari et al.,[3] in which based on IL-6 levels participants (n = 132) were segregated into three groups and then correlated with the clinical condition of the patients. In their study, 88% of patients with raised IL-6 levels had clinically severe COVID; in our study, 75% had severe COVID, so the results are compatible. However, in nonsevere cases, 63.2% of patients in our study and 43.4% in their study had raised IL-6 levels highlighting the fact that a significant proportion of nonsevere patients who were asymptomatic or had mild-to-moderate symptoms had raised IL-6 levels. Similar picture was observed in the study conducted by Liu et al.,[4] in which almost 60% of patients with nonsevere COVID had raised IL-6 levels, clearly indicating that higher IL-6 serum levels failed to predict the severity of the disease.Table 2: Comparison of interleukin-6 with different studiesWe also analyzed normal NLR (<3.5) and raised NLR (≥3.5) with serum IL-6 levels and compared the results with the study conducted by Talwar et al. In their study, 60% of patients with normal IL-6 had normal NLR; in our study, it came to be 72.7%; our results are in concordance with Talwar et al.[5] in this category. In those having raised IL-6 levels, in the study done by Talwar et al., 85% had raised NLR also, whereas in our study, in those with raised IL-6 levels, only 45% of these patients had raised NLR. 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引用次数: 0

摘要

因此,这一类别存在差异,因为在我们的研究中,尽管IL-6水平升高,但大多数患者NLR正常[表3]。表3:白细胞介素-6与中性粒细胞/淋巴细胞比率的比较我们的研究没有显示白细胞介素-6水平升高与NLR之间的任何相关性。还注意到,与患有严重疾病的人(28.6 pg/ml)相比,非严重类别的平均IL-6水平(35.6 pg/ml)不知何其高。因此,综上所述,入院时的血清IL-6水平无法预测COVID患者的严重程度。这一发现支持了IL-6受体拮抗剂治疗中重度COVID的可疑性质,因为一些评估IL-6受体拮抗剂治疗中重度病例疗效的研究未能显示出预期结果。财政支持和赞助利益冲突没有利益冲突。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Role of interleukin-6 levels in predicting COVID severity: A single-center experience
The COVID-19 pandemic has changed the entire perspective of health-care scenario globally. Our fight against this virus is to enable ourselves to recognize early warning signs or biomarkers in those infected so that they can be allocated adequate health-care resources to decrease mortality and morbidity. It was for this reason that we analyzed the hematological parameter neutrophil-to-lymphocyte ratio (NLR) and inflammatory biomarker cytokine interleukin (IL)-6 to evaluate whether they can be used to predict the severity of COVID-19 infection and also to study if any significant association exist between the two. These parameters can be easily analyzed even in primary health-care setting to effectively triage patients requiring tertiary care/L-3 facilities. This study was conducted on 100 reverse transcription–polymerase chain reaction confirmed COVID-positive patients. The patients were then categorized into mild, moderate, and severe COVID at the time of admission according to the criteria laid down by symptoms and SpO2 levels at room air as defined by ICMR COVID guidelines by the Ministry of Health and Family Welfare[1] (MOHFW), Government of India, revised on January 14, 2022 – Mild disease – Upper respiratory tract symptoms and/or fever without shortness of breath or hypoxia Moderate disease – Any one of: Respiratory rate ≥24/min, SpO2: 90% to ≤93% on room air Severe disease – Any one of: Respiratory rate >30/min, SpO2 <90% on room air. For ease of comparison and to effectively evaluate high-risk patients, mild and moderate categories were clubbed together into nonsevere as they can be managed in L-2 facility. However, those falling in the severe category require L-3 facilities with advanced infrastructure and ICU facilities and are, therefore, categorized separately. Levels of IL-6 and NLR were compared between the two groups. NLR was derived by dividing the percentage of neutrophils to the percentage of lymphocytes after calculating differential leukocyte count taking the normal upper limit of NLR as 3.5, as identified by Forget et al.[2] for the adult nongeriatric population in good health.[2] The mean value of NLR in mild, moderate, and severe categories was 3.9, 3.1, and 6.7, respectively. On combining mild and moderate categories as nonsevere, the mean values of NLR obtained were 3.7, almost half of the NLR mean values observed in the severe category, i.e., 6.7. On applying the analysis of variance (ANOVA) t-test, a significant statistical correlation (P = 0.016) of NLR was found with clinical severity. Cytokine IL-6 is an inflammatory cytokine that has a role in different pathological conditions such as infections, inflammations, and in cancers. IL-6 is also considered the main culprit responsible for hyperinflammation, causing lung damage and eventually death in severe cases of COVID-19. The normal upper limit for IL-6 was set as 7 pg/ml. Out of 100 patients, those in the mild category had mean IL-6 levels of 30.8 pg/ml, moderate patients had a mean value of 47.1 pg/ml, and severe category had a mean value of 28.6 pg/ml. Clubbing mild and moderate categories together, mean IL-6 values were 35.6 pg/ml in the nonsevere category, while it was 28.6 pg/ml in the severe category [Table 1]. On applying ANOVA t-test for the strength of significance between groups, no significant association was found between IL-6 levels and clinical severity (P = 0.510).Table 1: Coronavirus disease 2019 severity and interleukin-6 levelsWith respect to IL-6, on comparing our results with other studies [Table 2], one Indian study undertaken by Bhandari et al.,[3] in which based on IL-6 levels participants (n = 132) were segregated into three groups and then correlated with the clinical condition of the patients. In their study, 88% of patients with raised IL-6 levels had clinically severe COVID; in our study, 75% had severe COVID, so the results are compatible. However, in nonsevere cases, 63.2% of patients in our study and 43.4% in their study had raised IL-6 levels highlighting the fact that a significant proportion of nonsevere patients who were asymptomatic or had mild-to-moderate symptoms had raised IL-6 levels. Similar picture was observed in the study conducted by Liu et al.,[4] in which almost 60% of patients with nonsevere COVID had raised IL-6 levels, clearly indicating that higher IL-6 serum levels failed to predict the severity of the disease.Table 2: Comparison of interleukin-6 with different studiesWe also analyzed normal NLR (<3.5) and raised NLR (≥3.5) with serum IL-6 levels and compared the results with the study conducted by Talwar et al. In their study, 60% of patients with normal IL-6 had normal NLR; in our study, it came to be 72.7%; our results are in concordance with Talwar et al.[5] in this category. In those having raised IL-6 levels, in the study done by Talwar et al., 85% had raised NLR also, whereas in our study, in those with raised IL-6 levels, only 45% of these patients had raised NLR. Hence, there was a disparity in this category as the majority of patients in our study had normal NLR despite raised IL-6 levels [Table 3].Table 3: Comparison between interleukin-6 and neutrophil-to-lymphocyte ratioOur study failed to show any correlation between raised IL-6 levels and NLR. It was also noticed that mean IL-6 levels were somehow higher in the nonsevere category (35.6 pg/ml) as compared to those having severe disease (28.6 pg/ml). Hence, to conclude, serum IL-6 levels done at the time of admission failed to predict severity in COVID patients. This finding supports the dubious nature of IL-6 receptor antagonists in treating moderate-to-severe COVID, as some of the studies done to assess the efficacy of IL-6 receptor antagonists to treat moderate-to-severe cases failed to show expected results. Financial support and sponsorship None. Conflicts of interest There are no conflicts of interest.
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来源期刊
Indian Journal of Medical Specialities
Indian Journal of Medical Specialities MEDICINE, GENERAL & INTERNAL-
自引率
16.70%
发文量
51
期刊介绍: The Indian Journal of Medical Specialities is an all-encompassing peer-reviewed quarterly journal. The journal publishes scholarly articles, reviews, case reports and original research papers from medical specialities specially pertaining to clinical patterns and epidemiological profile of diseases. An important highlight is the emphasis on undergraduate and postgraduate medical education including various aspects of scientific paper-writing. The journal gives priority to research originating from the developing world, including from the tropical regions of the world. The journal also publishes special issues on health topics of current interest. The Indian Journal of Medical Specialities is one of the very few quality multispeciality scientific medical journals.
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