Department of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas.
Department of Medicine, Burrell College of Osteopathic Medicine, Las Cruces, New Mexico.
J Med Virol. 2021 Jan;93(1):491-498. doi: 10.1002/jmv.26288. Epub 2020 Jul 15.
Respiratory failure in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection appears related to cytokine release syndrome that often results in mechanical ventilation (MV). We investigated the role of tocilizumab (TCZ) on interleukin-6 (IL-6) trends and MV in patients with SARS-CoV-2. In this longitudinal observational study, 112 patients were evaluated from 1 February to 31 May 2020. TCZ was administered followed by methylprednisolone to patients with >3L oxygen requirement and pneumonia severity index score ≤130 with computed tomography scan changes. IL-6, C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), D-dimer, and procalcitonin were monitored on days 0, 3, and 6 of therapy. Statistical analyses were performed with significance ≤0.05. Eighty out of 112 SARS-CoV-2-positive patients (45 males, 56.96%; 34 females, 43.04%) were included in this study. Seven patients expired (8.75%) and nine patients required MV (11.25%). Median IL-6 levels pre-administration of TCZ was 342.50 (78.25-666.25) pg/mL compared with post-administration on day 3 (563; 162-783) pg/mL (P < .00001). On day 6, the median dropped to 545 (333.50-678.50) pg/mL compared with day 3 (P = .709). CRP, ferritin, LDH, and D-dimer levels were reduced after TCZ therapy. Early use of TCZ may reduce the need for MV and decrease CRP, ferritin, LDH, and D-dimer levels. The sequential use of methylprednisolone for 72 hours seems to potentiate the effect and prolong the suppression of the cytokine storm. IL-6 levels may be helpful as a prognostic tool.
严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 感染引起的呼吸衰竭似乎与细胞因子释放综合征有关，后者常导致机械通气 (MV)。我们研究了托珠单抗 (TCZ) 对 SARS-CoV-2 患者白细胞介素-6 (IL-6) 趋势和 MV 的作用。在这项纵向观察性研究中，我们对 2020 年 2 月 1 日至 5 月 31 日期间的 112 名患者进行了评估。TCZ 联合甲泼尼龙用于需要 >3L 氧需求和肺炎严重指数评分≤130 分且 CT 扫描有变化的患者。在治疗的第 0、3 和 6 天监测 IL-6、C 反应蛋白 (CRP)、铁蛋白、乳酸脱氢酶 (LDH)、D-二聚体和降钙素原。统计分析的显著性水平为≤0.05。112 例 SARS-CoV-2 阳性患者中，80 例(45 例男性，56.96%；34 例女性，43.04%)纳入本研究。7 例患者死亡(8.75%)，9 例患者需要 MV(11.25%)。TCZ 给药前 IL-6 中位数为 342.50(78.25-666.25)pg/ml，给药后第 3 天为 563(162-783)pg/ml(P<0.00001)。第 6 天，中位数降至 545(333.50-678.50)pg/ml，与第 3 天相比差异有统计学意义(P=0.709)。TCZ 治疗后 CRP、铁蛋白、LDH 和 D-二聚体水平降低。早期使用 TCZ 可能减少 MV 的需求，并降低 CRP、铁蛋白、LDH 和 D-二聚体水平。序贯使用 72 小时甲泼尼龙似乎增强了这种作用并延长了细胞因子风暴的抑制作用。IL-6 水平可能有助于作为一种预后工具。
