Beneficial effect of corticosteroids in preventing mortality in patients receiving tocilizumab to treat severe COVID-19 illness

International Journal of Infectious Diseases

Mar Ronda¹  Maria Quero²  Albert Ariza-Sole²  Joan Sabater³  Eugenia Santacana³  Ramon Jodar⁴  Pau Cerda⁴  Sergi Yun⁴  Virginia Esteve⁵  Maylin Koo⁵  Xavier Corbella⁶  Rafael Moreno-Gonzalez⁶  Elisabet Leiva⁷  Paolo D. Dallaglio⁷  Merce Gasa⁸  Mariona Llaberia⁸  Nuria Padulles⁸  Olga Capdevila⁸  Abelardo Montero⁸  Marta Fanlo⁸  Josep Comin-Colet⁸  Carlos García-Forero⁸  Francesc Formiga⁸  Jose M. Mora⁸  Manuel Rubio-Rivas⁸  Xavier Pinto⁸  Josep Llop⁸  Ferran Bolao⁸  Josep M. Cruzado⁸  Jordi Guardiola⁸  David Chivite⁸  Antoni Riera-Mestre⁸  Antoni Sabate⁸  Arnau Antoli⁹  Francesca Mitjavila^1,10  Salud Santos^1,10  Ariadna Padulles^1,10  Xavier Solanich^1,10  Alberto Pasqualetto^1,10  Monica Gonzalez^1,10  Antonio Soriano^1,10  Xose L. Perez-Fernandez^1,11  Guillermo Suarez-Cuartin^1,11  Adriana Iriarte^1,12 

[1] Corresponding authors at: Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, 08907 L’Hospitalet de Llobregat, Barcelona, Spain.;Innate Immunity and Pathology of Critical Patient-IDIBELL, Barcelona, Spain;Research Network in Respiratory Diseases (CIBERES), Madrid, Spain;Department of Anesthesiology and Reanimation, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain;Department of Cardiology, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain;Department of Gastroenterology, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain;Department of Intensive Care, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain;Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain;Department of Nephrology, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain;Department of Pharmacy, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain;Department of Pulmonary Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain;School of Medicine, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain;

关键词: COVID-19;    Tocilizumab;    Corticosteroids;    Systemic inflammation;    Mortality;   

DOI  :  

来源: DOAJ

【 摘 要 】

Objectives: To assess the characteristics and risk factors for mortality in patients with severe coronavirus disease-2019 (COVID-19) treated with tocilizumab (TCZ), alone or in combination with corticosteroids (CS). Methods: From March 17 to April 7, 2020, a real-world observational retrospective analysis of consecutive hospitalized adult patients receiving TCZ to treat severe COVID-19 was conducted at our 750-bed university hospital. The main outcome was all-cause in-hospital mortality. Results: A total of 1,092 patients with COVID-19 were admitted during the study period. Of them, 186 (17%) were treated with TCZ, of which 129 (87.8%) in combination with CS. Of the total 186 patients, 155 (83.3 %) patients were receiving noninvasive ventilation when TCZ was initiated. Mean time from symptoms onset and hospital admission to TCZ use was 12 (±4.3) and 4.3 days (±3.4), respectively. Overall, 147 (79%) survived and 39 (21%) died. By multivariate analysis, mortality was associated with older age (HR = 1.09, p < 0.001), chronic heart failure (HR = 4.4, p = 0.003), and chronic liver disease (HR = 4.69, p = 0.004). The use of CS, in combination with TCZ, was identified as a protective factor against mortality (HR = 0.26, p < 0.001) in such severe COVID-19 patients receiving TCZ. No serious superinfections were observed after a 30-day follow-up. Conclusions: In patients with severe COVID-19 receiving TCZ due to systemic host-immune inflammatory response syndrome, the use of CS in addition to TCZ therapy, showed a beneficial effect in preventing in-hospital mortality.

【 授权许可】

Unknown