Interleukin-6 and Ferritin as Prognosticators in SARS-CoV-2 Patients from Kashmir, North India

Iqra Farooq

Department of Biochemistry, Government Medical College, Srinagar, Jammu and Kashmir, India.

Rafiqa Eachkoti *

Department of Biochemistry, Government Medical College, Srinagar, Jammu and Kashmir, India.

Masood Tanvir

Department of Medicine, Government Medical College, Srinagar, Jammu and Kashmir, India.

Saleem Hussain

Department of Clinical Hematology, Sher-i-Kashmir Institute of Medical Sciences Srinagar, Jammu and Kashmir, India.

Sanah Farooq

Department of Biochemistry, Government Medical College, Srinagar, Jammu and Kashmir, India.

Ifrah Jan

Department of Clinical Biochemistry, University of Kashmir, Srinagar, Jammu and Kashmir, India.

Sadaf Saleem

Department of Biochemistry, Government Medical College, Srinagar, Jammu and Kashmir, India.

Sabhiya Majid

Department of Biochemistry, Government Medical College, Srinagar, Jammu and Kashmir, India.

*Author to whom correspondence should be addressed.


Abstract

Background: Identifying early predictive biomarkers of disease severity and disease outcome is fundamental for the practical management of Covid -19 patients. Although prognostic value of several Pro- and inflammatory markers have been determined in different population studies, however, it remained to be determined in SARS-CoV-2 patients from Kashmir.

Aim: To evaluate the predictive value of ferritin and IL-6 levels in RT- PCR confirmed SARS-CoV-2 patients from Kashmir.

Study Design: A Cohort Study.

Place and Duration of Study: The study was done at Government Medical College, Srinagar Kashmir, North India between October 2020 to November 2021.

Method: Here, we estimated ferritin and IL-6 levels respectively by chemiluminescent method on fully automated immune analyzer and by ELISA in a cohort of 100 RT-PCR confirmed SARS-CoV-2 patients, which were followed twice (14th and 28th day) for a period of  one month.

Results: Based on estimated ferritin levels, the cohort was categorized into Mild = <500 ng/ml, Moderate = ≥500-<1500, and High = ≥1500ng/ml. Also patients were grouped as Mild = 0-<10pg/ml, Moderate = ≥10-<80pg/ml and High =≥80pg/ml based on Interleukin IL-6 levels. Correlation analysis of SARS-CoV-2 patients of varying ferritin levels with disease severity revealed a percent increase in the number of patients of stage 3 severity as ferritin levels increased from mild, to moderate and high levels. Similarly, a percent increase in the number of SARS-CoV-2 patients of increased severity was found as IL-6 levels increased from mild to moderate and high levels. Further, the ROC analysis of ferritin and IL-6 levels with disease outcome suggested both ferritin and IL-6 as early predictive markers of poor disease outcome. However, IL-6, with AUC =0.70 and sensitivity of 70% and specificity of 62%, is a better early predictive marker of poor disease outcome than ferritin with AUC=0.66 at sensitivity of 60% and specificity of 68% in SARS-CoV-2 patients from Kashmir. Further ROC analysis of patients with very high ferritin levels (>1500ng/ml) alone suggests it as an early predictive marker of patients with hyperinflammatory phenotype.

Conclusion: Estimation of ferritin and IL-6 levels as simple complementary early prognostic markers that are helpful in clinical decision-making and selecting appropriate treatment options in SARS-CoV-2 patients from Kashmir, North India.

Keywords: Ferritin, IL-6, cytokine storm, SARS-CoV-2, pathophysiology, RT-PCR


How to Cite

Farooq , I., Eachkoti , R., Tanvir , M., Hussain , S., Farooq , S., Jan , I., Saleem , S., & Majid, S. (2023). Interleukin-6 and Ferritin as Prognosticators in SARS-CoV-2 Patients from Kashmir, North India. Asian Journal of Biochemistry, Genetics and Molecular Biology, 13(1), 37–50. https://doi.org/10.9734/ajbgmb/2023/v13i1287

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