Abstract
Background: Tocilizumab is an interleukin-6 inhibitor that reduces mortality and the need for invasive mechanical ventilation, while increasing the possibility of successful hospital discharge for hyperinflammatory patients with severe coronavirus disease 2019 (COVID-19). No increase in adverse events or serious infections has been reported previously.
Aim: To describe the characteristics and outcomes of patients with severe COVID-19 in critical care who received tocilizumab, and to compare mortality and length of hospital stay for patients who received tocilizumab (N=41) with those who did not (N=33).
Methods: Retrospective review of data related to patients with COVID-19 who received tocilizumab in a critical care setting from 1 st January to 31 st December 2021.
Findings: Amongst COVID-19 survivors, those who had received tocilizumab had longer intensive care unit (ICU) stays (median length 21 vs 9 days) and hospital stays (45 vs 34 days) compared with those who had not received tocilizumab. Thirty-day mortality (29% vs 36%; P=0.5196) and 60-day mortality (37% and 42%; P=0.6138) were not significantly lower in patients who received tocilizumab. Serious bacterial and fungal infections occurred at higher frequency amongst patients who received tocilizumab [odds ratio (OR) 2.67, 95% confidence interval (CI) 1.04-6.86; P=0.042], and at significantly higher frequency than in non-COVID-19 ICU admissions (OR 5.26, 95% CI 3.08-9.00; P<0.0001).
Conclusions: In this single-centre study, patients in critical care with severe COVID-19 who received tocilizumab had a greater number of serious bacterial and fungal infections, but this may not have been a direct effect of tocilizumab treatment.
Keywords: COVID-19; COVID-19 mortality; COVID-19 secondary infections; Tocilizumab.
【저자키워드】 COVID-19, tocilizumab., COVID-19 mortality, COVID-19 secondary infections, 【초록키워드】 Treatment, Critical care, Mortality, intensive care, severe COVID-19, Tocilizumab, interleukin-6, outcome, ICU, Characteristics, Survivors, adverse event, Patient, ICU admission, inhibitor, fungal infections, Bacterial, Invasive mechanical ventilation, Frequency, Fungal infection, Hospital stay, retrospective review, Non-COVID-19, 95% CI, 95% confidence interval, severe coronavirus disease, hospital discharge, significantly lower, Hyperinflammatory, greater, occurred, reported, median, increase in, significantly higher, reduce, patients with COVID-19, serious infection, 【제목키워드】 Treatment, Critical care, Tocilizumab, incidence, Bacterial, Fungal infection, Hyperinflammatory, invasive, elevated, patients with COVID-19,