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


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          COVID-19 can manifest as a viral induced hyperinflammation with multi-organ involvement. Such patients often experience rapid deterioration and need for mechanical ventilation. Currently, no prospectively validated biomarker of impending respiratory failure is available.


          We aimed to identify and prospectively validate biomarkers that allow the identification of patients in need of impending mechanical ventilation.


          Patients with COVID-19 hospitalized from February 29 th to April 09 th, 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).


          We identified markers of inflammation, LDH and creatinine as most predictive variables of respiratory failure in the evaluation cohort. Maximal interleukin-6 (IL-6) levels before intubation showed the strongest association with the need of mechanical ventilation followed by maximal CRP. Respective AUC values for IL-6 and CRP in the evaluation cohort were 0.97 and 0.86 and similar in the validation cohort 0.90 and 0.83. The calculated optimal cutoff values in the course of disease from the evaluation cohort (IL-6> 80 pg/ml and CRP> 97 mg/l) both correctly classified 80% of patients in the validation cohort regarding their risk of respiratory failure.


          Maximal levels of IL-6 followed by CRP were highly predictive of the need for mechanical ventilation. This suggests the possibility of using IL-6 or CRP levels to guide escalation of treatment in patients with COVID-19 related hyperinflammatory syndrome.

          Capsule summary

          We studied laboratory parameters as predictors of impending respiratory failure in COVID-19. Maximum levels of interleukin-6 over the course of disease, followed by CRP, were the best predictors of respiratory failure in two separate cohorts.

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          Author and article information

          J Allergy Clin Immunol
          J. Allergy Clin. Immunol
          The Journal of Allergy and Clinical Immunology
          Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology.
          18 May 2020
          18 May 2020
          [1 ]Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
          [2 ]Emergency Department, University Hospital, LMU Munich, Munich, Germany
          [3 ]Nine-i Investigator
          [4 ]Research Unit Apoptosis in Hematopoietic Stem Cells, Helmholtz Zentrum München, German Center for Environmental Health (HMGU), Munich, Germany
          [5 ]Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
          [6 ]Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, Scotland, UK
          [7 ]COVID-19 Registry of the Ludwig-Maximilian-University Hospital Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany
          [8 ]Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
          [9 ]Department of Neurology, University Hospital, LMU Munich, Munich, Germany
          [10 ]Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
          [11 ]DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, 80802 Munich, Germany
          Author notes
          [# ]Corresponding Author: Tobias Herold, MD; Marchioninistr. 15; 81377 Munich; Germany; Phone: +49 89 4400-44877; FAX: +49 89 4400-74242; tobias.herold@ 123456med.uni-muenchen.de

          Contributed equally

          © 2020 Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology.

          Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.


          interleukin-6,il-6,crp,covid-19,respiratory failure,mechanical ventilation,prediction,hyperinflammation


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