Relationship between disease severity and serum IL-6 levels in COVID-19 anosmia

Am J Otolaryngol. Jan-Feb 2021;42(1):102796. doi: 10.1016/j.amjoto.2020.102796. Epub 2020 Oct 28.


Background: An association between IL-6 levels and cytokine storm syndrome in COVID-19 patients has been suggested. Cases with higher IL-6 levels have more rapid progression and a higher complication rate. On the other hand, COVID-19 cases with anosmia have a milder course of the disease.

Objective: We aimed to investigate whether there is a relationship between serum IL-6 levels and presence of anosmia in COVID-19 patients.

Methods: Patients with a confirmed diagnosis of COVID-19 based on laboratory (PCR) were stratified into two groups based on presence of olfactory dysfunction (OD). In all cases with and without anosmia; psychophysical test (Sniffin' Sticks test) and a survey on olfactory symptoms were obtained. Threshold (t) - discrimination (d) - identification (i), and total (TDI) scores reflecting olfactory function were calculated. Clinical symptoms, serum IL-6 levels, other laboratory parameters, and chest computed tomography (CT) findings were recorded.

Results: A total of 59 patients were included, comprising 23 patients with anosmia and 36 patients without OD based on TDI scores. Patients with anosmia (41.39 ± 15.04) were significantly younger compared to cases without anosmia (52.19 ± 18.50). There was no significant difference between the groups in terms of comorbidities, smoking history, and symptoms including nasal congestion and rhinorrhea. Although serum IL-6 levels of all patients were above normal values (7 pg/mL), patients with anosmia had significantly lower serum IL-6 levels (16.72 ± 14.28 pg/mL) compared to patients without OD (60.95 ± 89.33 pg/mL) (p = 0.026).

Conclusion: Patients with COVID-19 related anosmia tend to have significantly lower serum levels of IL-6 compared to patients without OD, and the lower IL-6 levels is related to milder course of the disease. With the effect of low cytokine storm and IL-6 level, it may be said that anosmic cases have a milder disease in COVID-19.

Keywords: Anosmia; COVID-19; Computed tomography; Cytokine storm; IL-6; Mild disease; Olfactory dysfunction; Prognosis; Sniffin' Sticks test; Threshold discrimination identification.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anosmia / blood
  • Anosmia / diagnosis*
  • Anosmia / etiology
  • Biomarkers / blood
  • COVID-19 / blood
  • COVID-19 / epidemiology*
  • Female
  • Humans
  • Interleukin-6 / blood*
  • Male
  • Middle Aged
  • Pandemics*
  • Retrospective Studies
  • SARS-CoV-2*
  • Severity of Illness Index
  • Smell / physiology*
  • Surveys and Questionnaires
  • Young Adult


  • Biomarkers
  • Interleukin-6