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.

中文翻译：

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IL-6 和 CRP 水平升高预示着 COVID-19 需要机械通气。

背景

2019 年冠状病毒病 (COVID-19) 可表现为病毒引起的多器官受累的过度炎症。此类患者往往病情迅速恶化，需要机械通气。目前，还没有经过前瞻性验证的即将发生呼吸衰竭的生物标志物。

客观的

我们的目的是识别并前瞻性验证生物标志物，以识别需要即将进行机械通气的患者。

方法

对 2020 年 2 月 29 日至 4 月 9 日住院的 COVID-19 患者在入院时和患病期间的基线临床和实验室检查结果进行了分析。来自 89 名可评估患者的数据可用于分析，其中包括初始评估队列 (n = 40)，随后是临时分离的验证队列 (n = 49)。

结果

我们将炎症标志物、乳酸脱氢酶和肌酐确定为评估队列中最能预测呼吸衰竭的变量。插管前最大 IL-6 水平与机械通气需求的相关性最强，其次是最大 CRP 水平。评估队列中IL-6和CRP水平的AUC值分别为0.97和0.86，并且在验证队列中相似（分别为0.90和0.83）。计算出的评估队列病程中的最佳截止值（IL-6 水平 > 80 pg/mL 和 CRP 水平 > 97 mg/L）均正确分类了验证队列中 80% 的患者的呼吸衰竭风险。

结论

IL-6 的最高水平，其次是 CRP 水平，可以高度预测是否需要机械通气。这表明可以使用 IL-6 或 CRP 水平来指导 COVID-19 相关高炎症综合征患者升级治疗。