Tocilizumab improves survival in severe COVID-19 pneumonia with persistent hypoxia: a retrospective cohort study with follow-up from Mumbai, India.
Tocilizumab improves survival in severe COVID-19 pneumonia with persistent hypoxia: a retrospective cohort study with follow-up from Mumbai, India.
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DOI：
10.1186/s12879-021-05912-3
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发表时间：
2021-03-05
影响因子：
3.7
通讯作者：
Bhavsar P
中科院分区：
文献类型：
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作者：
Gokhale Y;Mehta R;Kulkarni U;Karnik N;Gokhale S;Sundar U;Chavan S;Kor A;Thakur S;Trivedi T;Kumar N;Baveja S;Wadal A;Kolte S;Deolankar A;Pednekar S;Kalekar L;Padiyar R;Londhe C;Darole P;Pol S;Gokhe SB;Padwal N;Pandey D;Yadav D;Joshi A;Badgujar H;Trivedi M;Shah P;Bhavsar P
2019年严重冠状病毒病（COVID-19）引发的细胞因子风暴与高死亡率相关。中国COVID-19相关死亡病例中报告的白细胞介素-6（IL-6）水平较高，因此IL-6被认为是COVID-19细胞因子风暴中的关键因素。托珠单抗是一种抗IL-6受体的单克隆抗体，用于治疗COVID-19细胞因子风暴。本研究的目的是评估托珠单抗对COVID-19细胞因子风暴所致死亡率的影响。这项回顾性观察性研究纳入了2020年3月31日至7月5日期间在印度孟买三级护理中心住院的重度COVID-19肺炎持续缺氧（定义为通过非再呼吸面罩补充氧气15 L/分钟或PaO 2/FiO 2比值低于200时的饱和度94%或更低）患者。除了标准护理，单次注射。2020年5月13日至7月5日，151名持续缺氧的COVID-19患者接受了托珠单抗400 mg静脉给药。对这151名患者进行了回顾性分析，并与历史对照进行了比较，即连续出现持续缺氧的COVID-19患者，定义如上所述（N = 118，从我们于2020年3月31日首次收治COVID-19到5月12日，即，直到托珠单抗在医院可用）。进行单因素和多因素考克斯回归分析，以确定生存的预测因素。使用IBM SPSS第26版进行统计分析。在2020年3月31日至7月5日研究的269例患者（托珠单抗组151例，历史对照组118例）中，托珠单抗组的中位生存期显著长于对照组; 18天（95% CI，11.3至24.7）vs 9天（95% CI，5.7至12.3）;对数秩p 0.007。在多变量考克斯回归分析中，生存期的独立预测因素是使用托珠单抗（HR 0.621，95% CI 0.427-0.903，P 0.013）和较高的血氧饱和度。托珠单抗可能改善持续缺氧的严重COVID-19肺炎患者的生存率。托珠单抗作为重度COVID-19肺炎伴缺氧（PaO 2/FiO 2低于200）患者的补救治疗的随机对照试验是必要的，因为炎症状态。
Cytokine storm triggered by Severe Coronavirus Disease 2019 (COVID-19) is associated with high mortality. With high Interleukin -6 (IL-6) levels reported in COVID-19 related deaths in China, IL-6 is considered to be the key player in COVID-19 cytokine storm. Tocilizumab, a monoclonal antibody against IL-6 receptor, is used on compassionate grounds for treatment of COVID-19 cytokine storm. The aim of this study was to assess effect of tocilizumab on mortality due to COVID-19 cytokine storm. This retrospective, observational study included patients of severe COVID-19 pneumonia with persistent hypoxia (defined as saturation 94% or less on supplemental Oxygen of 15 L per minute through non-rebreathing mask or PaO2/FiO2 ratio of less than 200) who were admitted to a tertiary care center in Mumbai, India, between 31st March to 5th July 2020. In addition to standard care, single Inj. Tocilizumab 400 mg was given intravenously to 151 consecutive COVID-19 patients with persistent hypoxia, from 13th May to 5th July 2020. These 151 patients were retrospectively analysed and compared with historic controls, ie consecutive COVID-19 patients with persistent hypoxia, defined as stated above (N = 118, from our first COVID-19 admission on 31st March to 12th May 2020 i.e., till tocilizumab was available in hospital). Univariate and multivariate Cox regression analysis was performed for identifying predictors of survival. Statistical analysis was performed using IBM SPSS version 26. Out of 269 (151 in tocilizumab group and 118 historic controls) patients studied from 31st March to 5th July 2020, median survival in the tocilizumab group was significantly longer than in the control group; 18 days (95% CI, 11.3 to 24.7) versus 9 days (95% CI, 5.7 to 12.3); log rank p 0.007. On multivariate Cox regression analysis, independent predictors of survival were use of tocilizumab (HR 0.621, 95% CI 0.427–0.903, P 0.013) and higher oxygen saturation. Tocilizumab may improve survival in severe COVID-19 pneumonia with persistent hypoxia. Randomised controlled trials on use of tocilizumab as rescue therapy in patients of severe COVID-19 pneumonia with hypoxia (PaO2/FiO2 less than 200) due to hyperinflammatory state, are warranted.
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影响因子：
25.4
作者：
Guaraldi, Giovanni;Meschiari, Marianna;Mussini, Cristina
通讯作者：
Mussini, Cristina
影响因子：
9
作者：
Channappanavar R;Perlman S
通讯作者：
Perlman S
影响因子：
158.5
作者：
Grein, J.;Ohmagari, N.;Flanigan, T.
通讯作者：
Flanigan, T.
DOI：
10.1016/j.cmi.2020.10.036
发表时间：
2021-03
期刊：
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
影响因子：
--
作者：
Tleyjeh IM;Kashour Z;Damlaj M;Riaz M;Tlayjeh H;Altannir M;Altannir Y;Al-Tannir M;Tleyjeh R;Hassett L;Kashour T
通讯作者：
Kashour T
影响因子：
15.1
作者：
Kewan, Tariq;Covut, Fahrettin;Akbik, Bassel
通讯作者：
Akbik, Bassel