Appropriate use of tocilizumab in COVID-19 infection
Appropriate use of tocilizumab in COVID-19 infection
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DOI：
10.1016/j.ijid.2020.07.036
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发表时间：
2020-10-01
影响因子：
8.4
通讯作者：
Ergonul, Onder
中科院分区：
文献类型：
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作者：
Keske, Siran;Tekin, Suda;Ergonul, Onder
目标：本研究旨在描述托珠单抗（TCZ）治疗的有效性和最佳使用的支持，临床，实验室和放射学observations.Methods：所有患者在医院进行了随访，每日白细胞介素-6（IL-6），C-反应蛋白（CRP），铁蛋白，D-二聚体，全血细胞计数，降钙素原。胸部计算机断层扫描（CT）进行了入院时，氧气支持是必要的，并在TCZ开始后7天。根据临床、实验室和放射学评估，将患者的病程分为严重或危重，结果：43例患者包括：70%为男性;中位年龄为64岁（最小-最大：27-94）; 6例（14%）患者死亡。在TCZ发作前，重症患者组的中位氧支持时间短于危重患者组（1天vs. 4天，p < 0.001）。21例在病房接受TCZ治疗的患者中有3例（14%）转入ICU，无死亡。重症病例组的IL-6、CRP、铁蛋白、D-二聚体和降钙素原水平显著低于危重病例组（分别为p = 0.025、p = 0.002、p = 0.008、p = 0.002和p = 0.001）。在TCZ的第七天观察到严重病例的放射学改善。结论：早期应用TCZ治疗COVID-19感染有利于患者的生存、住院时间和氧支持时间。TCZ给药的建议是基于氧支持需求增加、胸部CT进展和炎症标志物（包括IL-6、CRP、铁蛋白和D-二聚体）升高以及淋巴细胞百分比降低。(C)2020作者（S）由Elsevier Ltd代表国际传染病学会出版。
Objective: This study aimed to describe the effectiveness and optimum use of tocilizumab (TCZ) treatment by the support of clinical, laboratory and radiologic observations.Methods: All patients were followed up in the hospital with daily interleukin-6 (IL-6), C-reactive protein (CRP), ferritin, D-dimer, full blood count, and procalcitonin. Thoracic computed tomography (CT) was performed on admission, when oxygen support was necessary, and seven days after TCZ started. Disease course of the patients was grouped as severe or critical, according to their clinical, laboratory and radiologic evaluations.Results: Forty-three patients were included: 70% were male; the median age was 64 years (minimum-maximum: 27-94); and six (14%) patients died. The median duration of oxygen support before the onset of TCZ was shorter among the severe patient group than the critical patient group (1 vs. 4 days, p < 0.001). Three cases of 21 (14%) who received TCZ in the ward were transferred to ICU, and none of them died. The levels of IL-6, CRP, ferritin, D-dimer, and procalcitonin were significantly lower in the severe cases group than the critical cases group (p = 0.025, p = 0.002, p = 0.008, p = 0.002, and p = 0.001, respectively). Radiological improvement was observed in severe cases on the seventh day of TCZ. Secondary bacterial infection was detected in 41% of critical cases, but none of the severe ones.Conclusion: Earlier use of TCZ in COVID-19 infection was beneficial for survival, length of hospitalization and duration of oxygen support. The recommendation for administration of TCZ was based on an increase in requirement of oxygen support, progression in thoracic CT, and elevation of inflammation markers, including IL-6, CRP, ferritin, and D-dimer, and decrease in % lymphocytes. (C) 2020 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.