Abstract
BackgroundCovid-19 is a disease with high morbidity and mortality among elderly residents of long-term care facilities (LTCF). During an outbreak of SARS-CoV-2 infection in the LTCF an effective screening tool is essential to identify the patients at risk for severe disease. We explored the role of interleukin 6 (IL-6) as a predictor for severe disease during the outbreak of Covid-19 in one LTCF in Slovakia.MethodsWe conducted a retrospective data analysis of cases of COVID-19, diagnosed during the outbreak in one LTCF in Slovakia between April 11, 2020, and May 5, 2020. Within 24 h after the diagnosis of Covid-19, clinical and laboratory screening was performed in the LTCF to identify patients in need of hospitalization. Patients with oxygen saturation below 90% were immediately referred to the hospital. Patients staying in the LFTC were monitored daily and those that developed hypoxemia were transferred to the hospital. We analyzed the association between the IL-6 at the initial assessment and development of hypoxemia during follow up and determined the cut-off of the IL-6 able to predict the development of hypoxemia requiring oxygen therapy.ResultsFifty-three patients (11 men, 42 women) with diagnosed Covid-19 were included in the analysis. 19 (53%) patients developed hypoxemia during the disease. Patients with hypoxemia had significantly higher concentrations of IL-6, C-reactive protein, procalcitonin, fibrinogen, total bilirubin, aspartate aminotransferase and alanine aminotransferase at initial screening. ROC analyses identified IL-6 as the most robust predictor of hypoxemia. The concentration of IL-6 > 24 pg/mL predicted the development of hypoxemia with the sensitivity of 100% and specificity of 88.9%. The positive and negative predictive values were 76.9, and 100% respectively.ConclusionsThe concentration of IL-6 > 24 pg/mL at initial assessment predicted the development of hypoxemia requiring hospitalization with excellent sensitivity and good specificity. IL-6 appears as a potential predictor for the development of the severe Covid-19 and might serve for early identification of patients in need of hospitalization. Further studies are needed to evaluate the robustness of the use of IL-6 as an effective screening tool for the severe course of Covid-19.
Highlights
Covid-19 is a disease with high morbidity and mortality among elderly residents of long-term care facilities (LTCF)
The concentration of interleukin 6 (IL-6) > 24 pg/mL at initial assessment predicted the development of hypoxemia requiring hospitalization with excellent sensitivity and good specificity
The baseline serum concentrations of IL6, C-reactive protein (CRP), procalcitonin, urea, creatinine, fibrinogen, Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), fasting glucose, total bilirubin and neutrophil count were significantly higher, and lymphocyte and eosinophil count was significantly lower in patients who developed hypoxemia
Summary
Covid-19 is a disease with high morbidity and mortality among elderly residents of long-term care facilities (LTCF). During an outbreak of SARS-CoV-2 infection in the LTCF an effective screening tool is essential to identify the patients at risk for severe disease. And highly comorbid residents of long-term care facilities (LTCF) are at high risk of Covid-19 associated morbidity and mortality [8,9,10]. And effective intervention is essential to reduce morbidity and mortality during the Covid-19 outbreak in the LTCF Such intervention consists of quick identification of cases, immediate introduction of infection control measures, initial triage, and daily monitoring of patients. The role of systematic measurement of IL-6, CRP, and other markers of inflammation at the initial assessment during Covid-19 outbreak in LTCF and its ability to predict the severe course of disease is yet to be determined
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