Tocilizumab treatment in critically ill patients with COVID-19: A retrospective observational study
| Autor: | Stanley C. Jordan, Sharon Isonaka, Haoshu Yang, Elisa Rosales, Erin Salce, Edmund Huang |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
0301 basic medicine medicine.medical_treatment Infectious and parasitic diseases RC109-216 law.invention chemistry.chemical_compound 0302 clinical medicine law 030212 general & internal medicine skin and connective tissue diseases Aged 80 and over Acute respiratory distress syndrome Respiratory disease General Medicine Middle Aged Tocilizumab Intensive care unit Cytokine release syndrome Infectious Diseases Female Adult Microbiology (medical) musculoskeletal diseases medicine.medical_specialty Critical Illness Secondary infection 030106 microbiology Antibodies Monoclonal Humanized Article 03 medical and health sciences Internal medicine medicine Humans Aged Retrospective Studies Mechanical ventilation SARS-CoV-2 business.industry COVID-19 Retrospective cohort study Pneumonia medicine.disease Respiration Artificial COVID-19 Drug Treatment chemistry SARS-CoV2 Cytokine storm business |
| Zdroj: | International Journal of Infectious Diseases, Vol 105, Iss, Pp 245-251 (2021) International Journal of Infectious Diseases |
| ISSN: | 1201-9712 |
| Popis: | Objective: Elevated levels of pro-inflammatory cytokines are observed in severe COVID-19 infections, and cytokine storm is associated with disease severity. Tocilizumab, an interleukin-6 receptor antagonist, is used to treat chimeric antigen receptor T cell-induced cytokine release syndrome and may attenuate the dysregulated immune response in COVID-19. We compared outcomes among tocilizumab-treated and non-tocilizumab-treated critically ill COVID-19 patients. Design, setting, and participants: This was a retrospective observational study conducted at a tertiary referral center investigating all patients admitted to the intensive care unit for COVID-19 who had a disposition from the hospital because of death or hospital discharge between March 1 and May 18, 2020 (n = 96). The percentages of death and secondary infections were compared between patients treated with tocilizumab (n = 55) and those who were not (n = 41). Measurements and main results: More tocilizumab-treated patients required mechanical ventilation (44/55, 80%) compared to non-treated patients (15/41, 37%; P < 0.001). Of 55 patients treated with tocilizumab, 32 (58%) were on mechanical ventilation at the time of administration, and 12 (22%) progressed to mechanical ventilation after treatment. Of patients treated with tocilizumab requiring mechanical ventilation, 30/44 (68%) were intubated within 1 day of administration. Fewer deaths were observed among tocilizumab-treated patients, both in the overall population (15% vs 37%; P = 0.02) and among the subgroup of patients requiring mechanical ventilation (14% vs 60%; P = 0.001). Secondary infections were not different between the 2 groups (tocilizumab: 31%, non-tocilizumab: 17%; P = 0.16) and were predominantly related to invasive devices, such as urinary and central venous catheters. Conclusions: Tocilizumab treatment was associated with fewer deaths compared to non-treatment despite predominantly being used in patients with more advanced respiratory disease. |
| Databáze: | OpenAIRE |
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