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Several treatments for COVID-19 have been tested, which can be divided into three main categories: drugs with direct antiviral effect, drugs with immunomodulatory effect, and neutralizing antibodies from convalescent plasma ( 8). During this last stage of the disease, values of several inflammatory markers are extremely high and macrophage activation syndrome may occur. Finally, stage III displays clinical manifestations of a severe systemic inflammatory syndrome, culminating in severe respiratory failure with an unfavorable prognosis. It is further divided into two groups, according to the presence (IIb) or absence (IIa) of hypoxemia. Stage II is characterized by cough, high fever, dyspnea, abnormal thoracic imaging, lymphopenia, and increased levels of inflammatory markers. Stage I is defined by mild unspecified symptoms, such as myalgia, dry cough, headache, and subfebrile temperature, without any laboratory and radiological abnormalities. This infection has been divided into three clinical stages, regarding the severity and prognosis ( 6, 7). Infection with SARS-CoV-2 comprehends two overlapping phases: the first, characterized by a high replicative activity of the virus, is then followed by a counteractive host immune response ( 5). The risk of severe disease and death increases with age and the presence of comorbidities ( 4). Although most cases present only mild symptoms, 20% of the patients develop severe pathology with acute bilateral pneumonia that may evolve to acute respiratory distress syndrome and multi-organ failure.
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel betacoronavirus, emerged at the end of 2019 in China and has already infected almost 90 million people worldwide, causing more than 1.9 million deaths and becoming a worldwide pandemic (coronavirus disease 2019, COVID-19) ( 2, 3). Herein, we present IL-6 as a relevant tool for prognostic evaluation, mainly as a predictor of outcome.Ĭoronaviruses are a family of single strain RNA viruses that infect several hosts, including humans, mainly causing respiratory infections ( 1).
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In a binary logistic regression, IL-6 level was the most significant predictor of the non-survivors group, when compared to age and CRP.
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However, when we assessed the predictive value of these two markers, IL-6 behaves as a better predictor of disease progression. Compared to the inflammatory markers available in the clinic routine, we found a positive correlation between IL-6 and C-reactive protein (CRP). Also, we found a significant negative correlation between IL-6 levels during stages IIb and III, peripheral oxygen saturation (SpO 2), and partial pressure of oxygen in arterial blood (PaO 2), showing that IL-6 correlates with respiratory failure. We found that IL-6 levels were significantly different between the disease stages. Our cohort consisted of 46 adult patients with PCR-proven SARS-CoV-2 infection admitted in a COVID-19 ward of the Hospital de Braga (HB) from April 7 to May 7, 2020, whose IL-6 levels were followed over time. Here, we proposed to assess the relationship between IL-6 and outcomes of patients with coronavirus disease 2019 (COVID-19). Several studies have indicated a “cytokine storm” with the release of interleukin-1 (IL-1), IL-6, and IL-8, along with tumor necrosis factor alpha (TNFα) and other inflammatory mediators. Predictive prognosis biomarkers to guide therapeutics are critically lacking. Hyper-inflammatory responses induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are a major cause of disease severity and death.