Diagnostics of macrophage activation syndrome, depending on IL-6 initial level in patients with a novel coronavirus infection

Abstract

Introduction. The novel coronavirus infection caused by the SARS-CoV-2 remains the main problem, which is being studied by all the efforts of the global scientific community. Large clinical recourse has been accumulated that allows to conduct more effective treatment of patients, but there are still unresolved issues on the pathogenesis for development and course of the disease. Materials and methods. The study included 163 patients admitted to the infectious diseases hospital diagnosed with Novel coronavirus infection caused by the SARS-CoV-2. Upon admission, all patient serum samples were quantified for IL-6 level that allowed to stratify patients into three groups: A 55 patients with IL-6 below 5.0 pg/ml. The mean age in the group was 57.314.9 years, body mass index (BMI) was 28.25.6 kg/m2; C 52 patients whose serum IL-6 level was in the range of 549 pg/ml. The average age in the group was 60.811.8 years, BMI 29.65.5 kg/m2; C 56 patients in whom the level of IL-6 in the blood serum ranged within 50300 pg/ml. The average age in the group was 62.515.6 years, BMI 28.85.6 kg/m2. Patients at admission were analysed for serum level of IL-6, IL-8, and C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH) were also determined on day 3 and 7. Results. The minimum production of IL-6 within the range of 0.15 pg/ml, corresponds to the minimum changes in IL-8, CRP, and ferritin as well as LDH that was within the range of physiological values. Moderate cytokinemia, IL-6 is within the range of 549 pg/ml was associated with elevated ferritin and LDH not tending to decline by the end of treatment. Significant cytokinemia, the level of IL-6 within the range of 50300 pg/ml was associated with hyperferritinemia and increased LDH. The course of COVID-19 in such patients is characterized by increased ferritin by day 3 of treatment, consistently high level of LDH, without a significant trend towards a decline in the studied markers by the end of treatment. Conclusion. The risk of developing macrophage activation syndrome is not observed of the serum IL-6 level was below 5 pg/ml, whereas ferritin and LDH were within the range of physiological values, with no/degree I ARF. Moderate macrophage activation syndrome is characterized by increased serum IL-6 level within the range 549 pg/ml, a moderate increase in LDH and ferritin, as well as signs of ARF III degree. Severe signs are diagnosed in case of serum IL-6 level exceeded 50 pg/ml, along with significant increase in LDH and ferritin, as well as signs of IIIII degree ARF.