Abstract
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.
Keywords: Acute respiratory distress syndrome; COVID-19; Cytokine release syndrome; Pneumonia; SARS-CoV2; Tocilizumab.
【저자키워드】 COVID-19, SARS-CoV2, acute respiratory distress syndrome, Tocilizumab, Pneumonia, Cytokine release syndrome, 【초록키워드】 Treatment, Cytokine storm, intensive care, mechanical ventilation, Tocilizumab, disease severity, hospital, outcome, Secondary infection, Critically ill, Respiratory disease, Patient, death, group, patients, chimeric antigen receptor, COVID-19 patients, interleukin-6 receptor, retrospective, administration, distress, Intubated, hospital discharge, treat, dysregulated immune response, pro-inflammatory cytokine, severe COVID-19 infections, measurement, venous, invasive, required, conducted, not different, attenuate, on mechanical ventilation, patients treated, percentage, progressed, subgroup of patient, 【제목키워드】 Treatment, retrospective, Critically ill patient,