Prognostic value of serum krebs von den lungen-6 glycoprotein circulating levels in COVID-19 pneumonia: A prospective cohort study

Lobo Prat, D.; Castellví, I.; Castillo, D.; Orozco, S.; Mariscal, A.; Martínez-Martínez, L.; Millán Arciniegas, A. M.; Moya, P.; Laiz, A.; Díaz-Torné, C.; Magallares, B.; Fernandez-Sanchez, S. P.; Jeria Navarro, S.; Sainz Comas, L.; Codes, H.; Casademont, J.; Domingo, P.; Corominas, H.

Background: Currently, there are no biomarkers to predict respiratory worsening in patients with Coronavirus infectious disease, 2019 (COVID-19) pneumonia. Objectives: We aimed to determine the prognostic value of Krebs von De Lungen-6 circulating serum levels (sKL-6) predicting COVID-19 evolving trends. Methods: We prospectively analyzed the clinical and laboratory characteristics of 375 COVID-19 patients with mild lung disease on admission. sKL-6 was obtained in all patients at baseline and compared among patients with respiratory worsening. Results: 45.1% of patients developed respiratory worsening during hospitalization. Baseline sKL-6 levels were higher in patients who had respiratory worsening (median [IQR] 303 [209-449] vs. 285.5 [15.8-5724], P=0.068). The best sKL-6 cut-off point was 408 U/mL (area under the curve 0.55;33% sensitivity, 79% specificity). Independent predictors of respiratory worsening were sKL-6 serum levels, age >51 years, time hospitalized, and dyspnea on admission. Patients with baseline sKL-6 ≥ 408 U/mL had a 39% higher risk of developing respiratory aggravation seven days after admission. In patients with serial determinations, sKL-6 was also higher in those who subsequently worsened (median [IQR] 330 [219-460] vs 290.5 [193-396];p<0.02). Conclusion: sKL-6 has a low sensibility to predict respiratory worsening in patients with mild COVID-19 pneumonia. Baseline sKL-6 ≥ 408 U/mL is associated to a higher risk of respiratory worsening. sKL-6 levels are not useful as a screening tool to stratify patients on admission but further research is needed to investigate if serial determinations of sKL-6 may be of prognostic use.