• Tobias Herold, Vindi Jurinovic, Chiara Arnreich, Brian J Lipworth, Johannes C Hellmuth, Michael von Bergwelt-Baildon, Matthias Klein, and Tobias Weinberger.
• Department of Medicine III, University Hospital, LMU Munich, Munich, Germany; Emergency Department, University Hospital, LMU Munich, Munich, Germany; Nine-i Network; Research Unit Apoptosis in Hematopoietic Stem Cells, Helmholtz Zentrum München, German Center for Environmental Health (HMGU), Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany. Electronic address: tobias.herold@med.uni-muenchen.de.
• J. Allergy Clin. Immunol. 2020 Jul 1; 146 (1): 128-136.e4.

BackgroundCoronavirus disease 2019 (COVID-19) can manifest as a viral-induced hyperinflammation with multiorgan involvement. Such patients often experience rapid deterioration and need for mechanical ventilation. Currently, no prospectively validated biomarker of impending respiratory failure is available.ObjectiveWe aimed to identify and prospectively validate biomarkers that allow the identification of patients in need of impending mechanical ventilation.MethodsPatients with COVID-19 who were hospitalized from February 29 to April 9, 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).ResultsWe identified markers of inflammation, lactate dehydrogenase, and creatinine as the variables most predictive of respiratory failure in the evaluation cohort. Maximal IL-6 level before intubation showed the strongest association with the need for mechanical ventilation, followed by maximal CRP level. The respective AUC values for IL-6 and CRP levels in the evaluation cohort were 0.97 and 0.86, and they were similar in the validation cohort (0.90 and 0.83, respectively). The calculated optimal cutoff values during the course of disease from the evaluation cohort (IL-6 level > 80 pg/mL and CRP level > 97 mg/L) both correctly classified 80% of patients in the validation cohort regarding their risk of respiratory failure.ConclusionThe maximal level of IL-6, followed by CRP level, was highly predictive of the need for mechanical ventilation. This suggests the possibility of using IL-6 or CRP level to guide escalation of treatment in patients with COVID-19-related hyperinflammatory syndrome.Copyright © 2020 American Academy of Allergy, Asthma & Immunology. All rights reserved.

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