Predictive validity of interleukin 6 (IL-6) for the mortality in critically ill COVID-19 patients with the B.1.617.2 (Delta) variant in Vietnam: a single-centre, cross-sectional study

• Published in: BMJ open 2024-12, Vol.14 (12), p.e085971
• Main Authors: Nguyen, Chi Van, Luong, Chinh Quoc, Dao, Co Xuan, Nguyen, My Ha, Pham, Dung Thi, Khuat, Nhung Hong, Pham, Quynh Thi, Hoang, Dat Tien, Nguyen, Anh Diep, Nguyen, Phuong Minh, Cao, Duong Dai, Pham, Dung Thuy, Nguyen, Thai Quoc, Nong, Vuong Minh, Dang, Dung Tuan, Nguyen, Dat Tuan, Nguyen, Vinh Duc, Le, Thuan Quang, Nguyen, Viet Khoi, Ngo, Hung Duc, Nguyen, Dung Van, Pham, Thach The, Nguyen, Dung Tien, Nguyen, Nguyen Trung, Do, Tan Dang, Huynh, Nhung Thi, Phan, Nga Thu, Nguyen, Cuong Duy, Vo, Khoi Hong, Vu, Thom Thi, Do, Cuong Duy, Dang, Tuan Quoc, Vu, Giap Van, Nguyen, Tan Cong, Do, Son Ngoc
• Format: Article
• Language: English
• Subjects: ACCIDENT & EMERGENCY MEDICINE; Adult intensive & critical care; Aged; Biomarkers - blood; Blood pressure; Cardiovascular disease; Comorbidity; COVID-19; COVID-19 - blood; COVID-19 - mortality; Critical Illness - mortality; Cross-Sectional Studies; Cytokine storm; Data collection; Emergency medical care; Female; Global health; Hospital Mortality; Hospitals; Humans; Infections; Intensive Care; Intensive Care Units - statistics & numerical data; Interleukin-6 - blood; Male; Medicine; Middle Aged; Mortality; Original Research; Patients; Predictive Value of Tests; ROC Curve; SARS-CoV-2; SARS-CoV-2 Infection; Severe acute respiratory syndrome coronavirus 2; Vietnam
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2024-085971

ObjectivesTo investigate the serum IL-6 levels and their rate of change in predicting the mortality of critically ill patients with COVID-19 in Vietnam.DesignA single-centre, cross-sectional study.SettingAn Intensive Care Centre for the Treatment of Critically Ill Patients with COVID-19 in Ho Chi Minh City, Vietnam.ParticipantsWe included patients aged 18 years or older who were critically ill with COVID-19 and presented to the study centre from 30 July 2021 to 15 October 2021. We excluded patients who did not have serum IL-6 measurements between admission and the end of the first day.Primary outcome measuresThe primary outcome was hospital all-cause mortality.ResultsOf 90 patients, 41.1% were men, the median age was 60.5 years (Q1–Q3: 52.0–71.0), and 76.7% of patients died in the hospital. Elevated IL-6 levels were observed on admission (41.79 pg/mL; Q1–Q3: 20.68–106.27) and on the third day after admission (72.00 pg/mL; Q1–Q3: 26.98–186.50), along with a significant rate of change in IL-6 during that period (839.5%; SD: 2753.2). While admission IL-6 level (areas under the receiver operator characteristic curve (AUROC): 0.610 (95% CI: 0.459 to 0.761); cut-off value ≥15.8 pg/mL) and rate of change in IL-6 on the third day of admission (AUROC: 0.586 (95% CI: 0.420 to 0.751); cut-off value ≥−58.7%) demonstrated poor discriminatory ability in predicting hospital mortality, the third day IL-6 rate of change from admission ≥−58.7% (adjusted OR: 12.812; 95% CI: 2.104 to 78.005) emerged as an independent predictor of hospital mortality.ConclusionsThis study focused on a highly selected cohort of critically ill COVID-19 patients with a high IL-6 level and mortality rate. Despite the poor discriminatory value of admission IL-6 levels, the rate of change in IL-6 proved valuable in predicting mortality. To identify critically ill COVID-19 patients with the highest risk for mortality, monitoring the serial serum IL-6 measurements and observing the rate of change in serum IL-6 levels over time are needed.