maicol concha - Academia.edu (original) (raw)
Papers by maicol concha
PROYECTO integrador de saberes, 2020
Journal of Critical Care, 2021
COVID-19 is characterized by a proinflammatory phenotype, with an underlying cytokine storm thoug... more COVID-19 is characterized by a proinflammatory phenotype, with an underlying cytokine storm thought to be key in determining disease severity. Levels of the proinflammatory cytokine interleukin-6 (IL-6) discriminate between patients with mild and severe disease, [1] making IL-6 inhibition an attractive therapeutic strategy [2]. Despite a common underlying aetiology of COVID-19, outcomes from clinical trials are not consistent. Whilst some studies demonstrate an association between the use of Tocilizumab and reduction in mortality [3], others have been terminated early due to excess mortality associated with Tocilizumab [4]. It is difficult to reconcile such conflicting data. We therefore explored the association between patient demographics, respiratory failure severity, and IL-6 levels on mortality in a cohort of hospitalized COVID-19 patients who were naïve to immunotherapy. Differences in clinical outcome between clinical trials may relate to variable pre-treatment levels of IL-6. We included patients aged ≥18 years admitted to University College London Hospitals with a positive real-time reverse transcriptionpolymerase chain reaction (rRT-PCR) test for SARS-CoV-2 RNA between 1 March and 30 June 2020, following local research ethics committee approval (REC reference 20/HRA/2505). Multiplex panels (MesoScale Discovery, Rockville, MD, USA) were used to analyse IL-6. For this analysis, blood was centrifuged within 4 h of collection, separated and sera frozen at −80°C before batch analysis. Continuous and categorical variables are reported as median (interquartile range) and n (%), respectively. Comparison of non-parametric continuous data between groups was performed using the Kruskal Wallis test (for comparison between >2 groups). Cytokine values were analysed on a logarithmic scale. Categorical data were compared using the chisquare test. Area under the receiver operator curve (AUROC) was constructed to ascertain the predictive value of IL-6 for mortality. Graphs were constructed, and statistical analysis performed using Prism 9.0 (GraphPad Software, La Jolla, CA, USA) and SPSS version 24.0 (IBM Corp). Eighty-six COVID-19 patients were included; 44 (51%) patients with mild disease, 22 (26%) with critical illness who survived, and 20 (23%) who died in hospital. Patients who died were older than those who survived critical illness or those with mild disease (both p = 0•002). Compared to patients with mild disease, progression to critical illness and death was associated with severity of respiratory failure (lower SpO 2 :FiO 2 ratio) (p < 0.001) and higher levels of CRP (p < 0•001) on admission (Table 1).
PROYECTO integrador de saberes, Jul 1, 2020
PROYECTO integrador de saberes, 2020
Journal of Critical Care, 2021
COVID-19 is characterized by a proinflammatory phenotype, with an underlying cytokine storm thoug... more COVID-19 is characterized by a proinflammatory phenotype, with an underlying cytokine storm thought to be key in determining disease severity. Levels of the proinflammatory cytokine interleukin-6 (IL-6) discriminate between patients with mild and severe disease, [1] making IL-6 inhibition an attractive therapeutic strategy [2]. Despite a common underlying aetiology of COVID-19, outcomes from clinical trials are not consistent. Whilst some studies demonstrate an association between the use of Tocilizumab and reduction in mortality [3], others have been terminated early due to excess mortality associated with Tocilizumab [4]. It is difficult to reconcile such conflicting data. We therefore explored the association between patient demographics, respiratory failure severity, and IL-6 levels on mortality in a cohort of hospitalized COVID-19 patients who were naïve to immunotherapy. Differences in clinical outcome between clinical trials may relate to variable pre-treatment levels of IL-6. We included patients aged ≥18 years admitted to University College London Hospitals with a positive real-time reverse transcriptionpolymerase chain reaction (rRT-PCR) test for SARS-CoV-2 RNA between 1 March and 30 June 2020, following local research ethics committee approval (REC reference 20/HRA/2505). Multiplex panels (MesoScale Discovery, Rockville, MD, USA) were used to analyse IL-6. For this analysis, blood was centrifuged within 4 h of collection, separated and sera frozen at −80°C before batch analysis. Continuous and categorical variables are reported as median (interquartile range) and n (%), respectively. Comparison of non-parametric continuous data between groups was performed using the Kruskal Wallis test (for comparison between >2 groups). Cytokine values were analysed on a logarithmic scale. Categorical data were compared using the chisquare test. Area under the receiver operator curve (AUROC) was constructed to ascertain the predictive value of IL-6 for mortality. Graphs were constructed, and statistical analysis performed using Prism 9.0 (GraphPad Software, La Jolla, CA, USA) and SPSS version 24.0 (IBM Corp). Eighty-six COVID-19 patients were included; 44 (51%) patients with mild disease, 22 (26%) with critical illness who survived, and 20 (23%) who died in hospital. Patients who died were older than those who survived critical illness or those with mild disease (both p = 0•002). Compared to patients with mild disease, progression to critical illness and death was associated with severity of respiratory failure (lower SpO 2 :FiO 2 ratio) (p < 0.001) and higher levels of CRP (p < 0•001) on admission (Table 1).
PROYECTO integrador de saberes, Jul 1, 2020