Tocilizumab for COVID-19 Acute Respiratory Distress Syndrome: Outcomes Assessment Using the WHO Ordinal Scale.
Tocilizumab for COVID-19 Acute Respiratory Distress Syndrome: Outcomes Assessment Using the WHO Ordinal Scale.
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DOI：
10.7759/cureus.12290
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发表时间：
2020-12-26
期刊：
影响因子：
--
通讯作者：
Jamil B
中科院分区：
文献类型：
--
作者：
Nasir N;Mahmood F;Habib K;Khanum I;Jamil B
COVID-19的细胞因子释放综合征以高炎症为特征，表现为急性呼吸窘迫综合征（ARDS）、多器官衰竭和高炎症参数。托珠单抗是一种白细胞介素6 （IL-6）拮抗剂，已被用于COVID-19 - ARDS，但世界不同地区的结果相互矛盾。目的应用世界卫生组织（WHO） COVID-19分级量表研究托珠单抗治疗COVID-19急性呼吸综合征合并高脂血症患者的疗效。方法对2020年2月~ 2020年5月合并高亢炎症的COVID-19 ARDS患者进行观察性研究。结果共收治244例COVID-19患者，其中发生ARDS 107例。30例患者同时患有急性呼吸窘迫综合征和高脂血症，并接受托珠单抗治疗。平均年龄62.5岁（SD: 13.5），以男性居多（83%）。治疗前平均CRP为217.5 mg/L，托珠单抗治疗48 ~ 72小时后平均CRP为98.5 mg/L。21例（70%）患者同时接受静脉注射甲基强的松龙。在30名患者中，7人死亡，20人康复。10例患者需要入住重症监护病房，9例发生院内感染。三名患者在接受托珠单抗治疗后被诊断出与covid -19相关的曲霉病。发生院内感染并需要间歇正压通气（IPPV）的患者死亡率明显更高。治疗后，在世卫组织评分中位数为5分的患者观察到临床改善。我们的研究支持在治疗前WHO有序严重程度评分中位数为5分的COVID-19 ARDS患者中使用托珠单抗，并建议监测医院感染和机会性感染。
Introduction Cytokine release syndrome in COVID-19 is characterized by hyperinflammation, which manifests as acute respiratory distress syndrome (ARDS), multiorgan failure, and high inflammatory parameters. Tocilizumab, an interleukin 6 (IL-6) antagonist has been used in COVID-19 ARDS with conflicting results from different parts of the world. Objective To study the treatment outcomes with tocilizumab in patients with COVID-19 ARDS and hyperinflammation using the World Health Organization (WHO) COVID-19 ordinal scale. Methods An observational study was conducted from Feb 2020 to May 2020 on COVID-19 ARDS patients with hyperinflammation. Results A total of 244 patients with COVID-19 were admitted, out of which 107 had ARDS. Thirty patients had both ARDS and hyperinflammation and received tocilizumab. The mean age was 62.5 years (SD: 13.5) and the majority were male (83%). The mean CRP pre-treatment was 217.5 mg/L and post 48 to 72 hours of tocilizumab treatment was 98.5 mg/L. Twenty-one patients (70%) also received concomitant intravenous (IV) methylprednisolone. Of the 30 patients, seven died and 20 recovered. Ten patients required intensive care unit admission and nine developed nosocomial infections. COVID-19-associated aspergillosis was diagnosed in three patients post tocilizumab treatment. Mortality was significantly higher in patients who developed a nosocomial infection and who required intermittent positive pressure ventilation (IPPV). Post-treatment, clinical improvement was observed in patients who had a median score of 5 on the WHO ordinal scale. Conclusion Our study supports the use of tocilizumab in COVID-19 ARDS patients with a pre-treatment median WHO ordinal severity score of 5 and recommends the monitoring of nosocomial infections and opportunistic infections.
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