RESUMO
BackgroundThe SARS-CoV-2 virus has become pandemic for the last 2 years. Inflammatory response to the virus leads to organ dysfunction and death. Predicting the severity of inflammatory response helps in managing critical patients using serology tests IgG and IgM. We conducted a longitudinal study to correlate serum SARS-CoV-2 IgM and IgG serology with clinical outcomes in COVID-19 patients. MethodsWe analyzed patient data from March to December of 2020 for those who were admitted at AIIMS Rishikesh. Clinical and laboratory data of these patients were collected from the e-hospital portal and analysed. Correlation was seen with clinical outcomes and was assessed using MS Excel 2010 and SPSS software. ResultsOut of 494 patients, the mean age of patients was 48.95 {+/-} 16.40 years and there were more male patients in the study (66.0%). The patients were classified into 4 groups; mild-moderate 328 (67.1%), severe 131 (26.8%) and critical 30 (6.1%). The mean duration from symptom onset to serology testing was 19.87 {+/-} 30.53 days. In-hospital mortality was observed in 25.1% patients. The seropositivity rate (i.e., either IgG or IgM >10 AU) was 50%. There was a significant difference between the 2 groups in terms of IgM Levels (AU/mL) (W = 33428.000, p = <0.001) and IgG Levels (AU/mL) (W = 39256.500, p = <0.001), with the median IgM/ IgG Levels (AU/mL) being highest in the RT-PCR-Positive group. There was no significant difference between the groups in terms of IgM Levels and IgG levels with all other clinical outcomes (disease severity, septic shock, Intensive care admission, mechanical ventilation and mortality). ConclusionSerology (IgM and IgG) levels are high in RTPCR positive group compared to clinical COVID-19. However, serology cannot be useful for the prediction of disease outcomes except few situations. The study also highlights the importance of doing serology at a particular time as antibody titres vary with the duration of the disease.
RESUMO
IntroductionCovid-19 has caused devastating effects worldwide ever since its origin in December, 2019. Till date, there is no definitive treatment for it. Deaths due to Covid-19 has largely been attributed to cytokine storm and organ dysfunctions, mainly ARDS. Therefore, the focus has been on using inflammatory markers as a marker of severity of the disease. IL-6 is one such marker which has been increasingly used in the management of Covid-19. We conducted a longitudinal study to investigate the role of IL-6 in diagnosis, treatment and prognosis of Covid-19 related cytokine storm. MethodologyPatients with Covid-19, who were admitted at AIIMS Rishikesh from March to December, 2020 were included in the study. Patients with no baseline IL-6 value at admission and for whom clinical data was not available were excluded. Clinical and laboratory data of these patients were collected from the e-hospital portal and entered in excel sheet. Correlation was seen with other inflammatory markers and outcomes were assessed using MS Excel 2010 and SPSS software. ResultsAt total of 131 patients were included in the study. Majority were males (74.8%), mean age of the subjects being 55.03+13.57 years, with a mean duration from symptom onset being 6.69+6.3 days. Most of them belonged to the WHO severe category (82.4%), with 46.56% having severe hypoxia at presentation and 61.8% of them having some comorbidity-diabetes mellitus being the commonest. Spearman Rank Correlation coefficient of IL-6 with D-dimer was 0.203, with LDH was -0.005, with Ferritin was 0.3, and with Uric acid was 0.123. 11 patients received Tocilizumab at a mean duration from symptom onset of 18.09 days, and 100% mortality was observed. Deaths were reported more in the group with IL-6 more than 40pg/ml (57.1% vs 40.2%,p=0.06). Similarly, ICU admissions and ventilator requirement were reported more in the IL-6 more than 40pg/ml group (95.9% vs 91.4%,p=0.32 and 55.1% vs 37.8%,p=0.05). ConclusionThe study showed that IL-6 can be used as a possible thrombotic cytokine marker. Higher values of IL-6 (>40pg/ml) are associated with more deaths, ICU admissions and ventilator requirement.
