Article ; Online: Clinical characteristics and predictors of survival in adults with coronavirus disease 2019 receiving tocilizumab.
2020 Volume 114, Page(s) 102512
Abstract: ... with 28 day in-hospital survival in patients with coronavirus disease 2019 (COVID-19) that received ... Coronavirus disease 2019 (COVID-19) can progress to cytokine storm that is associated with organ ... clinical characteristics, severity of illness scores, or treatments received between survivors and non ...
| Abstract | Coronavirus disease 2019 (COVID-19) can progress to cytokine storm that is associated with organ dysfunction and death. The purpose of the present study is to determine clinical characteristics associated with 28 day in-hospital survival in patients with coronavirus disease 2019 (COVID-19) that received tocilizumab. This was a retrospective observational cohort study conducted at a five hospital health system in Michigan, United States. Adult patients with confirmed COVID-19 that were admitted to the hospital and received tocilizumab for cytokine storm from March 1, 2020 through April 3, 2020 were included. Patients were grouped into survivors and non-survivors based on 28 day in-hospital mortality. Study day 0 was defined as the day tocilizumab was administered. Factors independently associated with in-hospital survival at 28 days after tocilizumab administration were assessed. Epidemiologic, demographic, laboratory, prognostic scores, treatment, and outcome data were collected and analyzed. Clinical response was collected and defined as a decline of two levels on a six-point ordinal scale of clinical status or discharged alive from the hospital. Of the 81 patients included, the median age was 64 (58-71) years and 56 (69.1%) were male. The 28 day in-hospital mortality was 43.2%. There were 46 (56.8%) patients in the survivors and 35 (43.2%) in the non-survivors group. On study day 0 no differences were noted in demographics, clinical characteristics, severity of illness scores, or treatments received between survivors and non-survivors. C-reactive protein was significantly higher in the non-survivors compared to survivors. Compared to non-survivors, recipients of tocilizumab within 12 days of symptom onset was independently associated with survival (adjusted OR: 0.296, 95% CI: 0.098-0.889). SOFA score ≥8 on day 0 was independently associated with mortality (adjusted OR: 2.842, 95% CI: 1.042-7.753). Clinical response occurred more commonly in survivors than non-survivors (80.4% vs. 5.7%; p < 0.001). Improvements in the six-point ordinal scale and SOFA score were observed in survivors after tocilizumab. Early receipt of tocilizumab in patients with severe COVID-19 was an independent predictor for in-hospital survival at 28 days. |
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| MeSH term(s) | Adult ; Aged ; Antibodies, Monoclonal, Humanized/administration & dosage ; Betacoronavirus/immunology ; C-Reactive Protein/analysis ; COVID-19 ; Coronavirus Infections/blood ; Coronavirus Infections/drug therapy ; Coronavirus Infections/immunology ; Coronavirus Infections/mortality ; Cytokine Release Syndrome/blood ; Cytokine Release Syndrome/drug therapy ; Cytokine Release Syndrome/immunology ; Cytokine Release Syndrome/mortality ; Female ; Hospital Mortality ; Humans ; Infusions, Intravenous ; Interleukin-6/immunology ; Interleukin-6/metabolism ; Male ; Michigan/epidemiology ; Middle Aged ; Organ Dysfunction Scores ; Pandemics ; Pneumonia, Viral/blood ; Pneumonia, Viral/drug therapy ; Pneumonia, Viral/immunology ; Pneumonia, Viral/mortality ; Prognosis ; Receptors, Interleukin-6/antagonists & inhibitors ; Receptors, Interleukin-6/metabolism ; Retrospective Studies ; SARS-CoV-2 ; Survival Analysis ; Time Factors ; Time-to-Treatment ; Treatment Outcome |
| Chemical Substances | Antibodies, Monoclonal, Humanized ; IL6 protein, human ; IL6R protein, human ; Interleukin-6 ; Receptors, Interleukin-6 ; C-Reactive Protein (9007-41-4) ; tocilizumab (I031V2H011) |
| Keywords | covid19 |
| Language | English |
| Publishing date | 2020-07-03 |
| Publishing country | England |
| Document type | Journal Article ; Multicenter Study ; Observational Study |
| ZDB-ID | 639452-8 |
| ISSN | 1095-9157 ; 0896-8411 |
| ISSN (online) | 1095-9157 |
| ISSN | 0896-8411 |
| DOI | 10.1016/j.jaut.2020.102512 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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