IL-6 Inhibition in Critically Ill COVID-19 Patients Is Associated With Increased Secondary Infections

Frontiers in Medicine

article

Lucas M. Kimmig¹  David Wu¹  Matthew Gold¹  Natasha N. Pettit¹  David Pitrak¹  Jeffrey Mueller⁴  Aliya N. Husain⁴  Ece A. Mutlu⁵  Gökhan M. Mutlu¹ 

[1] Department of Medicine, University of Chicago, United States;Section of Pulmonary and Critical Care Medicine, University of Chicago, United States;Section of Infectious Diseases, University of Chicago, United States;Department of Pathology, University of Chicago, United States;Section of Gastroenterology and Hepatology, Rush University, United States

关键词: COVID-19;    SARS-CoV-2;    tocilizumab;    cytokine release syndrome;    immunosuppression;   

DOI  :  10.3389/fmed.2020.583897

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

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.

【 授权许可】

CC BY