Prompt Predicting of Early Clinical Deterioration of Moderate-to-Severe COVID-19 Patients: Usefulness of a Combined Score Using IL-6 in a Preliminary Study

Alessandra Vultaggio, Emanuele Vivarelli, Gianni Virgili, Ersilia Lucenteforte, Alessandro Bartoloni, Carlo Nozzoli, Alessandro Morettini, Andrea Berni, Danilo Malandrino, Oliviero Rossi, Francesca Nencini, Filippo Pieralli, Adriano Peris, Filippo Lagi, Giulia Scocchera, Michele Spinicci, Michele Trotta, Marcello Mazzetti, Paola Parronchi, Lorenzo CosmiFrancesco Liotta, Paolo Fontanari, Alessio Mazzoni, Lorenzo Salvati, Enrico Maggi, Francesco Annunziato, Fabio Almerigogna, Andrea Matucci*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

19 Citations (Scopus)


Background: The early identification of patients at risk of clinical deterioration is of interest considering the timeline of COVID-19 after the onset of symptoms. Objective: The aim of our study was to evaluate the usefulness of testing serum IL-6 and other serological and clinical biomarkers, to predict a short-term negative clinical course of patients with noncritical COVID-19. Methods: A total of 208 patients with noncritical COVID-19 pneumonia at admission were consecutively enrolled. Clinical and laboratory findings obtained on admission were analyzed by using survival analysis and stepwise logistic regression for variable selection. Three-day worsening as outcome in a logistic model to generate a prognostic score was used. Results: Clinical worsening occurred in 63 patients (16 = died; 39 = transferred to intensive care unit; 8 worsening of respiratory failure). Forty-five of them worsened within 3 days after admission. The risk of clinical worsening was progressively enhanced along with increasing quartiles of IL-6 levels. Multivariate analysis showed that IL-6 (P =.005), C-reactive protein (CRP) (P =.003), and SaO2/FiO2 (P =.014) were the best predictors for clinical deterioration in the first 3 days after admission. The combined score yielded an area under the curve = 0.88 (95% confidence interval: 0.83-0.93). A nomogram predicting the probability of 3-day worsening was generated. The score also showed good performance for 7-day and 14- or 21-day worsening and in predicting death occurring during all the follow-up. Conclusions: Combining IL-6, CRP, and SaO2/FiO2 in a score may help clinicians to identify on admission those patients with COVID-19 who are at high risk for a further 3-day clinical deterioration.

Original languageEnglish
Pages (from-to)2575-2581.e2
JournalJournal of Allergy and Clinical Immunology: In Practice
Issue number8
Early online date19 Jun 2020
Publication statusPublished - Sep 2020
Externally publishedYes

Bibliographical note

Funding Information:
We thank Jane Griffith for English language revision.

Publisher Copyright:
© 2020 American Academy of Allergy, Asthma & Immunology

Copyright 2020 Elsevier B.V., All rights reserved.


  • C-reactive protein
  • COVID-19
  • IL-6
  • Risk factors
  • SARS-CoV-2

ASJC Scopus subject areas

  • Immunology and Allergy

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