IL-6 Inhibition in Critically Ill COVID-19 Patients Is Associated With Increased Secondary Infections.
IL-6 Inhibition in Critically Ill COVID-19 Patients Is Associated With Increased Secondary Infections.
复制标题
重症患者的IL-6抑制作用与继发感染增加有关。
DOI：
10.3389/fmed.2020.583897
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发表时间：
2020
影响因子：
3.9
通讯作者：
Mutlu GM
中科院分区：
文献类型：
--
作者：
Kimmig LM;Wu D;Gold M;Pettit NN;Pitrak D;Mueller J;Husain AN;Mutlu EA;Mutlu GM
背景：新冠肺炎的抗炎治疗，如IL-6抑制，是在循证治疗的真空中提出的。然而，在传染病中取消炎症反应可能会损害所需的宿主反应，并预先准备好应对继发性感染。方法：我们回顾了8周内新冠肺炎危重患者的病历，比较了接受和未接受托西珠单抗治疗的患者的继发感染发生率和预后。此外，我们纳入了在我们机构进行尸检的几个新冠肺炎病例的代表性组织病理学尸检结果。结果：111例患者中，54例接受了tocilizumab治疗，57例未接受治疗。接受tocilizumab治疗的患者继发细菌感染的风险(48.1%比28.1%；p=0.029)和真菌感染的风险(5.6%比0%；p=0.112)更高。与较高的感染数量一致，接受tocilizumab治疗的患者的死亡率较高(35.2vs.19.3%；p=0.020)。7例进行了尸检。在接受tocilizumab治疗的3例患者中，病理上有肺炎的证据。在未服用tocilizumab的四例患者中，两例显示有吸入性肺炎的证据，两例显示弥漫性肺泡损伤。结论：实验疗法目前正在临床试验之外应用于新冠肺炎。抗炎治疗，如抗IL-6治疗，可能会损害病毒的清除，容易发生二次感染，并造成伤害。我们寻求提高医生对这些问题的认识，并强调更好地了解新冠肺炎的免疫反应的必要性。
Background: Anti-inflammatory therapies such as IL-6 inhibition have been proposed for COVID-19 in a vacuum of evidence-based treatment. However, abrogating the inflammatory response in infectious diseases may impair a desired host response and pre-dispose to secondary infections. Methods: We retrospectively reviewed the medical record of critically ill COVID-19 patients during an 8-week span and compared the prevalence of secondary infection and outcomes in patients who did and did not receive tocilizumab. Additionally, we included representative histopathologic post-mortem findings from several COVID-19 cases that underwent autopsy at our institution. Results: One hundred eleven patients were identified, of which 54 had received tocilizumab while 57 had not. Receiving tocilizumab was associated with a higher risk of secondary bacterial (48.1 vs. 28.1%; p = 0.029 and fungal (5.6 vs. 0%; p = 0.112) infections. Consistent with higher number of infections, patients who received tocilizumab had higher mortality (35.2 vs. 19.3%; p = 0.020). Seven cases underwent autopsy. In three cases who received tocilizumab, there was evidence of pneumonia on pathology. Of the four cases that had not been given tocilizumab, two showed evidence of aspiration pneumonia and two exhibited diffuse alveolar damage. Conclusions: Experimental therapies are currently being applied to COVID-19 outside of clinical trials. Anti-inflammatory therapies such as anti-IL-6 therapy have the potential to impair viral clearance, pre-dispose to secondary infection, and cause harm. We seek to raise physician awareness of these issues and highlight the need to better understand the immune response in COVID-19.
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影响因子：
8
作者：
Morena, Valentina;Milazzo, Laura;Corbellino, Mario
通讯作者：
Corbellino, Mario
影响因子：
5.6
作者：
Narazaki M;Kishimoto T
通讯作者：
Kishimoto T
影响因子：
64.8
作者：
KOPF, M;BAUMANN, H;KOHLER, G
通讯作者：
KOHLER, G
DOI：
10.1073/pnas.2005615117
发表时间：
2020-05-19
影响因子：
11.1
作者：
Xu, Xiaoling;Han, Mingfeng;Wei, Haiming
通讯作者：
Wei, Haiming
影响因子：
5.5
作者：
Lang, Veronika R.;Englbrecht, Matthias;Zwerina, Jochen
通讯作者：
Zwerina, Jochen