| Autor: |
Antony, Suresh J., Davis, Michelle A., Davis, Monique G., Almaghlouth, Nouf K., Guevara, Roberto, Omar, Fahad, Del Rey, Fernando, Hassan, Ali, Arian, Muhammad U., Antony, Nishaal, Prakash, Bharat V. |
| Předmět: |
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| Zdroj: |
Journal of Medical Virology; Jan2021, Vol. 93 Issue 1, p491-498, 8p |
| Abstrakt: |
Respiratory failure in severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection appears related to cytokine release syndrome that often results in mechanical ventilation (MV). We investigated the role of tocilizumab (TCZ) on interleukin‐6 (IL‐6) trends and MV in patients with SARS‐CoV‐2. In this longitudinal observational study, 112 patients were evaluated from 1 February to 31 May 2020. TCZ was administered followed by methylprednisolone to patients with >3L oxygen requirement and pneumonia severity index score ≤130 with computed tomography scan changes. IL‐6, C‐reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), D‐dimer, and procalcitonin were monitored on days 0, 3, and 6 of therapy. Statistical analyses were performed with significance ≤0.05. Eighty out of 112 SARS‐CoV‐2‐positive patients (45 males, 56.96%; 34 females, 43.04%) were included in this study. Seven patients expired (8.75%) and nine patients required MV (11.25%). Median IL‐6 levels pre‐administration of TCZ was 342.50 (78.25‐666.25) pg/mL compared with post‐administration on day 3 (563; 162‐783) pg/mL (P <.00001). On day 6, the median dropped to 545 (333.50‐678.50) pg/mL compared with day 3 (P =.709). CRP, ferritin, LDH, and D‐dimer levels were reduced after TCZ therapy. Early use of TCZ may reduce the need for MV and decrease CRP, ferritin, LDH, and D‐dimer levels. The sequential use of methylprednisolone for 72 hours seems to potentiate the effect and prolong the suppression of the cytokine storm. IL‐6 levels may be helpful as a prognostic tool. Highlights: Interleukin‐6 (IL‐6) is the major chemokine that drives the cytokine release syndrome observed in acutely ill patients with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2).We used IL‐6, C‐reactive protein, ferritin, lactate dehydrogenase, D‐dimer, and procalcitonin to evaluate SARS‐CoV‐2 disease progression pre‐ and post‐tocilizumab therapy in 80 patients.These proinflammatory markers may be helpful as a prognostic tool in the management of patients with SARS‐CoV‐2.The early use of tocilizumab may reduce the need for mechanical ventilation and reduce these proinflammatory markers. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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