Comparative Survival Analysis of Immunomodulatory Therapy for Coronavirus Disease 2019 Cytokine Storm

Autor: Sonali Narain, Prashant Malhotra, Ona Bloom, Sanjaya K. Satapathy, David Hirschwerk, Alice S. Chau, Negin Hajizadeh, Michael Qiu, Matthew D. Taylor, Naomi I Maria, Dimitre G. Stefanov, Audrey Liu, Martin Lesser, Jennifer Cookingham, Blanka Kaplan, Cristina Sison, Andrew G. Weber, Stuart L. Cohen, Galina Marder
Rok vydání: 2021
Předmět:
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Medication Therapy Management
coronavirus
Disease
Antibodies
Monoclonal
Humanized
Critical Care and Intensive Care Medicine
Severity of Illness Index
corticosteroids
Immunomodulation
tocilizumab
chemistry.chemical_compound
Tocilizumab
Adrenal Cortex Hormones
Internal medicine
Diabetes mellitus
Correspondence
medicine
Electronic Health Records
Humans
Survival analysis
Original Research
Retrospective Studies
Anakinra
biology
SARS-CoV-2
business.industry
Hazard ratio
C-reactive protein
Drug Repositioning
COVID-19
Middle Aged
medicine.disease
Survival Analysis
infection
United States
Interleukin 1 Receptor Antagonist Protein
Outcome and Process Assessment
Health Care
chemistry
biology.protein
Drug Therapy
Combination
Cytokine Release Syndrome
Cardiology and Cardiovascular Medicine
business
Cytokine storm
Immunosuppressive Agents
anakinra
medicine.drug
Zdroj: Chest
ISSN: 0012-3692
Popis: Background Cytokine storm is a marker of COVID-19 illness severity and increased mortality. Immunomodulatory treatments have been repurposed to improve mortality outcomes. Research Question To identify if immunomodulatory therapies improve survival in patients with COVID-19 cytokine storm. Study Design and Methods We conducted a retrospective analysis of electronic health records across the Northwell Health system. COVID-19 patients hospitalized between March 1, 2020 and April 24, 2020 were included. Cytokine storm was defined by inflammatory markers: ferritin >700ng/mL, C-reactive protein >30mg/dL or lactate dehydrogenase >300U/L. Patients were subdivided into six groups—no immunomodulatory treatment (standard of care) and five groups that received either corticosteroids, anti-interleukin 6 antibody (tocilizumab) or anti-interleukin-1 therapy (anakinra) alone or in combination with corticosteroids. The primary outcome was hospital mortality. Results 5,776 patients met the inclusion criteria. The most common comorbidities were hypertension (44-59%), diabetes (32-46%) and cardiovascular disease (5-14%). Patients most frequently met criteria with high lactate dehydrogenase (76.2%) alone or in combination, followed by ferritin (63.2%) and C-reactive protein (8.4%). More than 80% of patients had an elevated D-dimer. Patients treated with corticosteroids and tocilizumab combination had lower mortality compared to standard of care (Hazard Ratio (HR):0.44, 95% confidence interval (CI): 0.35-0.55; p
Databáze: OpenAIRE
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