ACMJ
Anatolian Current Medical Journal

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Original Article
Comparison of clinical outcomes of intensive care patients with COVID-19 pneumonia receiving and not receiving tocilizumab treatment
Abstract
Aims: In patients with Coronavirus disease 2019 (COVID-19) infection, a situation called cytokine storm and an increase in proinflammatory cytokines such as interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-1 (IL-1) in the blood has been observed and it has been found that this is clinically related to the development of severe disease. Therefore, tocilizumab (TCZ) therapy that blocks IL-6 will reduce the immunological response and thus potentially harm caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The aim of this study is to determine the effect of TCZ treatment on length of hospital stay, need for invasive mechanical ventilation and mortality in COVID-19 patients followed in the tertiary intensive care unit. Material and
Methods: This retrospective cross-sectional study was conducted among patients hospitalized with the diagnosis of COVID-19 pneumonia between 01.09.2020 and 01.01.21 in intensive care units. Data were analyzed and evaluated separately in patients who received and did not receive TCZ treatment. Patients older than 18 years of age, who were hospitalized for at least 24 hours with the diagnosis of COVID-19 pneumonia and needed ?36 hours of oxygen therapy, were not referred to another health center, were included in this study. Pregnant and lactating women were not included in the study. Patients with missing at least one data in the parameters to be evaluated were excluded from the study. Patients treated with an IL-6 inhibitor other than TCZ were excluded.
Results: After excluding patients who did not meet the inclusion criteria, 565 patients were included in the study. It was found that patients who received TCZ treatment after propensity score matching (PSM) had a significantly higher mean age (P<0.001) and lower obesity rates (P=0.002). There was no significant difference between the patients who received and did not receive TCZ treatment in terms of mechanical ventilation need, length of hospital stay and mortality (P=0.505, P=0.661, P=0.834).
Conclusion: As a result of our research, it was seen that TCZ treatment did not affect the need for invasive mechanical ventilation, hospital and intensive care unit stay, and mortality.

Keywords : COVID-19, pneumonia, tocilizumab, intensive care unit

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1. Zengin EN. Research trends and global productivity onmechanical ventilation with the impact of COVID-19: abibliometric analysis in the period 1980-2021. J Health Sci Med2022; 5: 1051-61.
2. Aydemir S, Hoşg&uuml;n D. The role of serum lipoprotein levels inpredicting independent short-term mortality in COVID-19patients. Anatolian Curr Med J 2022; 4: 162-6
3. Uysal E, Seğmen F, Ulubaşoğlu P, Zengin EN, Erdem D. Theprogress of chronic renal disease patients followed by thediagnosis of COVID-19 in ICU. J Health Sci Med 2022; 5: 1447-52.
4. Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirusoutbreak of global health concern. The Lancet 2020; 395: 470-3.
5. Chen N, Zhou M, Dong X, et al. Epidemiological and clinicalcharacteristics of 99 cases of 2019 novel coronavirus pneumoniain Wuhan, China: a descriptive study. The Lancet 2020; 395: 507-13.
6. Huang C, Wang Y, Li X, et al. Clinical features of patients infectedwith 2019 novel coronavirus in Wuhan, China. The Lancet 2020;395: 497-06.
7. Wu R, Wang L, Kuo HCD, et al. An update on current therapeuticdrugs treating COVID-19. Current Pharmacology Reports 2020;6: 56-70.
8. Zhang C, Wu Z, Li JW, Zhao H, Wang GQ. Cytokine releasesyndrome in severe COVID-19: interleukin-6 receptor antagonisttocilizumab may be the key to reduce mortality. Int J AntimicrobAgents 2020; 55: 105954.
9. Hunter CA, Jones SA. IL-6 as a keystone cytokine in health anddisease. Nat Immunol 2015; 16: 448-57.
10. Soy&ouml;z M, Kılı&ccedil;aslan Ayna T, Pirim İ. Overview of COVID-19infection from immunological perspective. Tepecik Eğit AraştHast Derg 2020; 30: 101-11.
11. Luo P, Liu Y, Qiu L, Liu X, Liu D, Li J. Tocilizumab treatmentin COVID-19: a single center experience. J Med Virol 2020; 92:814-8.
12. Republic of Turkey Ministry of Health General Directorate ofPublic Health. COVID-19 (SARS-CoV-2 infection) anticytokine-anti-inflammatory therapies, coagulopathy managementscientific advisory board study. T.R. Ministry of Health 7November 2020, Ankara.
13. Nidadavolu LS, Walston JD. Underlying vulnerabilities to thecytokine storm and adverse COVID-19 outcomes in the agingimmune system. J Gerontol A Biol Sci Med Sci 2021; 76: e13-8.
14. Mo P, Xing Y, Xiao Y, et al. Clinical characteristics of refractorycoronavirus disease 2019 in Wuhan, China. Clin Infect Dis 2021;73: e4208-13.
15. Du Y, Lv Y, Zha W, Zhou N, Hong X. Association of body massindex (BMI) with critical COVID-19 and in-hospital mortality:A dose-response meta-analysis. Metabolism 2021; 117: 154373.
16. Palaiodimos L, Kokkinidis DG, Li W, et al. Severe obesity,increasing age and male sex are independently associated withworse in-hospital outcomes, and higher in-hospital mortality,in a cohort of patients with COVID-19 in the Bronx, New York.Metabolism 2020; 108: 154262.
17. Shcherbak SG, Anisenkova AY, Mosenko SV, et al. Basicpredictive risk factors for cytokine storms in COVID-19 patients.Front Immunol 2021; 12: 745515.
18. Guaraldi G, Meschiari M, Cozzi-Lepri A, et al. Tocilizumab inpatients with severe COVID-19: a retrospective cohort study.Lancet Rheumatol 2020; 2: e474-84.
19. Salvarani C, Dolci G, Massari M, et al. Effect of tocilizumabvs standard care on clinical worsening in patients hospitalizedwith COVID-19 pneumonia: a randomized clinical trial. JAMAIntern Med 2021; 181: 1-9.
20. Campochiaro C, Della-Torre E, Cavalli G, et al. Efficacy andsafety of tocilizumab in severe COVID-19 patients: a single-centre retrospective cohort study. Eur J Intern Med 2020; 76: 43-9.
21. Alberdi-Iglesias A, Mart&iacute;n-Rodr&iacute;guez F, Ortega Rabbione G, etal. Role of SpO2/FiO2 Ratio and ROX Index in Predicting EarlyInvasive Mechanical Ventilation in COVID-19. A Pragmatic,Retrospective, Multi-Center Study. Biomedicines 2021; 9: 1036.
22. Catoire P, Tellier E, de la Rivi&egrave;re C, et al. Assessment of the SpO2/FiO2 ratio as a tool for hypoxemia screening in the emergencydepartment. Am J Emerg Med 2021; 44: 116-120.
23. Klopfenstein T, Zayet S, Lohse A, et al. Impact of tocilizumabon mortality and/or invasive mechanical ventilation requirementin a cohort of 206 COVID-19 patients. Int J Infect Dis 2020; 99:491-5.
24. Salama C, Han J, Yau L, et al. Tocilizumab in Patients Hospitalizedwith COVID-19 Pneumonia. N Engl J Med 2021; 384: 20-30.
25. Guven BB, Erturk T, Kompe &Ouml;, Ersoy A. Serious complications inCOVID-19 ARDS cases: pneumothorax, pneumomediastinum,subcutaneous emphysema and haemothorax. Epidemiol Infect2021; 149: e137.
26. Zhou C, Gao C, Xie Y, Xu M. COVID-19 with spontaneouspneumomediastinum. Lancet Infect Dis 2020; 20: 510.
27. Sun R, Liu H, Wang X. Mediastinal emphysema, giant bulla,and pneumothorax developed during the course of COVID-19pneumonia. Korean J Radiol 2020; 21: 541-4.
28. Rossotti R, Travi G, Ughi N, et al. Safety and efficacy of anti-il6-receptor tocilizumab use in severe and critical patients affectedby coronavirus disease 2019: A comparative analysis. J Infect2020; 81: e11-7.
29. Martinelli AW, Ingle T, Newman J, et al. COVID-19 andpneumothorax: a multicentre retrospective case series. EurRespir J 2020; 56: 2002697.
30. Colaneri M, Bogliolo L, Valsecchi P, et al. Tocilizumab fortreatment of severe COVID-19 patients: Preliminary results fromSMAtteo COVID-19 Registry (SMACORE). Microorganisms2020; 8: 695.
31. Moreno-P&eacute;rez O, Andres M, Leon-Ramirez JM, et al. Experiencewith tocilizumab in severe COVID-19 pneumonia after 80 daysof follow-up: A retrospective cohort study. J Autoimmun 2020;114: 102523.
32. Biran N, Ip A, Ahn J, et al. Tocilizumab among patients withCOVID-19 in the intensive care unit: a multicentre observationalstudy. Lancet Rheumatol 2020; 2: e603-12.
33. De Rossi N, Scarpazza C, Filippini C, et al. Early use of low dosetocilizumab in patients with COVID-19: A retrospective cohortstudy with a complete follow-up. EClinicalMedicine 2020; 25:100459.
34. Rosas IO, Br&auml;u N, Waters M, et al. Tocilizumab in HospitalizedPatients with Severe COVID-19 Pneumonia. N Engl J Med 2021;384: 1503-16.
35. Hermine O, Mariette X, Tharaux PL, et al. Effect of tocilizumab vsusual care in adults hospitalized with COVID-19 and moderateor severe pneumonia: a randomized clinical trial. JAMA InternMed 2021; 181: 32-40.
36. Stone JH, Frigault MJ, Serling-Boyd NJ, et al. Efficacy oftocilizumab in patients hospitalized with COVID-19. N Engl JMed 2020; 383: 2333-44.
37. Veiga VC, Prats JAGG, Farias DLC, et al. Effect of tocilizumabon clinical outcomes at 15 days in patients with severe or criticalcoronavirus disease 2019: randomised controlled trial. BMJ2021; 372: n84.
38. Lan SH, Lai CC, Huang HT, Chang SP, Lu LC, Hsueh PR.Tocilizumab for severe COVID-19: a systematic review andmeta-analysis. Int J Antimicrob Agents 2020; 56: 106103.
39. Galv&aacute;n-Rom&aacute;n JM, Rodr&iacute;guez-Garc&iacute;a SC, Roy-Vallejo E, et al.IL-6 serum levels predict severity and response to tocilizumabin COVID-19: An observational study. J Allergy Clin Immunol2021; 147: 72-80.e8.
40. Austin PC. An Introduction to propensity score methodsfor reducing the effects of confounding in observationalstudies. Multivar Behav Res 2011; 46: 399-424.
Article available in :
Volume 5, Issue 1, 2023
Page : 39-46
https://doi.org/10.38053/acmj.1198167
Article Information
Submitted : 02 Kas 2022
Accepted : 29 Ara 2022
Corresponding Author :

Eda Yaman: Department of Emergency Medicine, Uşak Training and Research Hospital, Uşak, Turkey

[email protected]
Citation : Dal H, Karabulut Keklik ES, Dağtekin G, et al. Comparison of clinical outcomes of intensive care patients with COVID-19 pneumonia receiving and not receiving tocilizumab treatment. Anatolian Curr Med J 2023; 5(1); 39-46.

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