Anästhesie und klinische Forschung
Offener Zugang

Abstrakt

Survival and Outcomes of Tocilizumab use in Severe and Critically-ill COVID-19 Patients not Responding to Steroids

Shiraz Assu*, Deepak Bhasin, Supriya Sampley, Harpal Singh, Gurleen Kaur, Kavita Sekhri

Background: Outcomes are poorest in severe and critical COVID-19 pneumonia. We share our experience with the use of interleukin-6 receptor inhibitor, tocilizumab in the above patient group when given along with steroids.

Methods: In this retrospective observational study, all severe and critical COVID-19 patients, who got admitted to the intensive care unit and subsequently received tocilizumab were included. Patients who worsened clinically or had no change in oxygen requirement even after 24 hrs of receiving intravenous methylprednisolone at a dose of 1-2 mg/kg/day had received a maximum total dose of 800 mg of intravenous tocilizumab. The day 28 all-cause mortality and progression to mechanical ventilation were the primary outcome measures. Clinical improvement, trends in oxygen requirements and inflammatory markers along with secondary infections rates were also noted.

Results: A total of 51 patients who did not show clinical improvement even after 24 hours of intravenous steroids had received tocilizumab. Following this, a significant decrease in oxygen requirement and clinical progression were observed by day 7. Twelve (24.5%) of the 49 patients who were on conventional or non-invasive oxygen support progressed to mechanical ventilation and the day 28 all-cause mortality was 10/51(19.6%). Irrespective of the outcome, CRP showed a significant decrease after the drug administration. However, rest of the inflammatory markers became significantly deranged in those with poorer outcome (day 3 ferritin (p=0.026), day 7 (p=0.041) ddimer and NLR (p=0.044)) as compared to patients who were alive at day 28. Life-threatening infections occurred in 19.6% of the 51 patients and were significantly more in those who expired on or before day 28. (70% vs. 7.3%, p<0.001).

Conclusion: Early and timely administration of tocilizumab is a viable option in selected severe and critical COVID-19 patients who do not respond to initial steroids. When given along with steroids, a high suspicion of secondary infections should be kept.