Profiling COVID-19 pneumonia progressing into the cytokine storm syndrome: results from a single Italian Centre study on tocilizumab versus standard of care
| Autor: | Salvatore De Vita, Tiziana Bove, Davide Pecori, Carlo Tascini, Francesco Curcio, Luca Quartuccio, Martina Fabris, Amato De Monte, Maddalena Peghin, Flavio Bassi, Dennis McGonagle, Arianna Sonaglia |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Male Anti-Inflammatory Agents coronavirus law.invention chemistry.chemical_compound 0302 clinical medicine Randomized controlled trial law Monoclonal 80 and over cytokine Medicine 030212 general & internal medicine Viral Young adult skin and connective tissue diseases Humanized intensive care Aged 80 and over Confounding Standard of Care Middle Aged Hospitals Cytokine release syndrome Treatment Outcome Infectious Diseases Italy Raised CRP Female Coronavirus Infections Cytokine Release Syndrome Adult musculoskeletal diseases medicine.medical_specialty Standard of care Coronavirus disease 2019 (COVID-19) Pneumonia Viral 030106 microbiology COVID-19 Coronavirus Cytokine Intensive care Tocilizumab Aged Antibodies Monoclonal Humanized Antiviral Agents Glucocorticoids Humans Immunologic Factors Inpatients Pandemics Retrospective Studies Young Adult Antibodies Article 03 medical and health sciences tocilizumab Internal medicine Virology business.industry Retrospective cohort study Pneumonia medicine.disease chemistry business Cytokine storm |
| Zdroj: | Journal of Clinical Virology |
| DOI: | 10.1101/2020.05.01.20078360 |
| Popis: | Highlights • There is an urgent need for markers of prognosis in COVID-19. • Higher inflammatory markers best select tocilizumab treatment. • The ward based tocilizumab group showed better responses and less infections than ICU tocilizumab group. • The former group may be the best for evaluating the impact of anti-cytokine therapy in COVID-19. • The known poor risk factors for COVID-19 infection were present in the TOCI treated rather than in the good prognosis standard of care group. Objective Approximately 5% of patients with coronavirus disease 2019 (COVID-19) develop a life-threatening pneumonia that often occurs in the setting of increased inflammation or “cytokine storm”. Anti-cytokine treatments are being evaluated but optimal patient selection remains unclear, and the aim of our study is to address this point. Methods Between February 29 to April 6, 2020, 111 consecutive hospitalized patients with COVID-19 pneumonia were evaluated in a single centre retrospective study. Patients were divided in two groups: 42 severe cases (TOCI) with adverse prognostic features including raised CRP and IL-6 levels, who underwent anti-cytokine treatments, mostly tocilizumab, and 69 standard of care patients (SOC). Results In the TOCI group, all received anti-viral therapy and 40% also received glucocorticoids. In TOCI, 62% of cases were ventilated and there were 3 deaths (17.8 ± 10.6 days, mean follow up) with 7/26 cases remaining on ventilators, without improvement, and 17/26 developed bacterial superinfection. One fatality occurred in the 15 TOCI cases treated on noninvasive ventilation and 1 serious bacterial superinfection. Of the 69 cases in SOC, there was no fatalities and no bacterial complications. The TOCI group had higher baseline CRP and IL-6 elevations (p |
| Databáze: | OpenAIRE |
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