The use of Tocilizumab in COVID-19 critically ill patients with renal impairment: a multicenter, cohort study.

Autor:	Aljuhani O; Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia., Al Sulaiman K; Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.; College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.; Saudi Critical Care Pharmacy Research (SCAPE) Platform, Riyadh, Saudi Arabia., B Korayem G; Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia., Alharbi A; Pharmaceutical Care Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia., Altebainawi AF; Pharmaceutical Care Services, King Salman Specialist Hospital, Hail Health Cluster, Ministry of Health, Hail, Saudi Arabia.; Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia., Aldkheel SA; Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia., Alotaibi SG; Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia., Vishwakarma R; Norwich Medical School, University of East Anglia, Norwich, UK., Alshareef H; Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia., Alsohimi S; Pharmaceutical Care Services, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.; Pharmaceutical Care Services, King Abdulaziz University Hospital, Jeddah, Saudi Arabia., AlFaifi M; Pharmaceutical Care Department, King Saud Medical City, Riyadh, Saudi Arabia., Al Shaya A; Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.; College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia., Alhaidal HA; College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Alsubaie RM; College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Alrashidi H; College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Albarqi KJ; College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Alangari DT; College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Alanazi RM; College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Altaher NM; College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia., Al-Dorzi HM; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.; Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Jazyk:	angličtina
Zdroj:	Renal failure [Ren Fail] 2023; Vol. 45 (2), pp. 2268213. Date of Electronic Publication: 2023 Oct 23.
DOI:	10.1080/0886022X.2023.2268213
Abstrakt:	Tocilizumab (TCZ) is recommended in patients with COVID-19 who require oxygen therapy or ventilatory support. Despite the wide use of TCZ, little is known about its safety and effectiveness in patients with COVID-19 and renal impairment. Therefore, this study evaluated the safety and effectiveness of TCZ in critically ill patients with COVID-19 and renal impairment. A multicenter retrospective cohort study included all adult COVID-19 patients with renal impairment (eGFR˂60 mL/min) admitted to the ICUs between March 2020 and July 2021. Patients were categorized into two groups based on TCZ use (Control vs. TCZ). The primary endpoint was the development of acute kidney injury (AKI) during ICU stay. We screened 1599 patients for eligibility; 394 patients were eligible, and 225 patients were included after PS matching (1:2 ratio); there were 75 TCZ-treated subjects and 150 controls. The rate of AKI was higher in the TCZ group compared with the control group (72.2% versus 57.4%; p  = 0.03; OR: 1.83; 95% CI: 1.01, 3.34; p  = 0.04). Additionally, the ICU length of stay was significantly longer in patients who received TCZ (17.5 days versus 12.5 days; p  = 0.006, Beta coefficient: 0.30 days, 95% CI: 0.09, 0.50; p  = 0.005). On the other hand, the 30-day and in-hospital mortality were lower in patients who received TCZ compared to the control group (HR: 0.45, 95% CI: 0.27, 0.73; p  = 0.01 and HR: 0.63, 95% CI: 0.41, 0.96; p  = 0.03, respectively). The use of TCZ in this population was associated with a statistically significantly higher rate of AKI while improving the overall survival on the other hand. Further research is needed to assess the risks and benefits of TCZ treatment in critically ill COVID-19 patients with renal impairment.
Databáze:	MEDLINE
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