Introduction/objectives: An interleukin-6 inhibition strategy could be effective in selected COVID-19 patients. The objective is to present our experience of tocilizumab use in patients with severe COVID-19. Methods: Observational retrospective cohort study. Hospitalized patients were evaluated by our multidisciplinary team for eventual use of tocilizumab. Patients with progressive ventilatory impairment and evidence of a hyperinflammatory state despite usual treatment received tocilizumab 8 mg/kg intravenous (maximum dose 800 mg), in addition to standard treatment. The use and time of use of mechanical ventilation (MV), the change of the Alveolar-arterial (A-a) gradient, of the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO 2 /FiO 2 ) and of inflammation laboratory parameters after 72 h of tocilizumab use was evaluated. Results: 29 patients received tocilizumab. 93.1% were men, 37.9% were obese, and 34.5% had hypertension. Of the 20 patients who were not on MV when receiving tocilizumab, 11 required non-invasive MV, for an average of 5 days, and one of them required intubation. A-a gradient, PaO 2 /FiO 2 , and inflammation parameters improved significantly. A better lymphocyte count, which improved significantly after tocilizumab use, was significantly associated with less use of MV. Five patients presented positive culture samples after tocilizumab, three being of clinical significance. A lower lymphocyte count was associated with having a positive culture. No other significant adverse events were seen. Conclusion: Our study suggests the utility and shows the safety of tocilizumab use in COVID-19 patients who have respiratory failure and evidence of hyperinflammation. Lymphocyte improvement was a predictor of good response.
【저자키워드】 COVID-19, Tocilizumab, lymphocyte, SARS-CoV 2, mechanical ventilalion, 【초록키워드】 Treatment, Inflammation, Respiratory failure, severe COVID-19, mechanical ventilation, interleukin-6, intubation, oxygen, hypertension, Lymphocyte count, Culture, hyperinflammation, adverse event, Patient, utility, COVID-19 patients, Evidence, hyperinflammatory state, dose, COVID-19 patient, intravenous, retrospective cohort study, Non-invasive, standard treatment, fractional inspired oxygen, average, obese, ventilatory, impairment, positive, parameter, men, effective, laboratory parameter, selected, significantly, addition, evaluated, required, receiving, less, PaO, 【제목키워드】 report, Latin,