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 |
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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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