Department of Medicine, Division of Nephrology, Transplant Immunology Laboratory, Transplant Immunotherapy Program, United States.
Department of Clinical Transformation, Cedars-Sinai Medical Center, Los Angeles, California, United States.
Int J Infect Dis. 2021 Apr;105:245-251. doi: 10.1016/j.ijid.2021.02.057. Epub 2021 Feb 17.
Elevated levels of pro-inflammatory cytokines are observed in severe COVID-19 infections, and cytokine storm is associated with disease severity. Tocilizumab, an interleukin-6 receptor antagonist, is used to treat chimeric antigen receptor T cell-induced cytokine release syndrome and may attenuate the dysregulated immune response in COVID-19. We compared outcomes among tocilizumab-treated and non-tocilizumab-treated critically ill COVID-19 patients.
DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective observational study conducted at a tertiary referral center investigating all patients admitted to the intensive care unit for COVID-19 who had a disposition from the hospital because of death or hospital discharge between March 1 and May 18, 2020 (n = 96). The percentages of death and secondary infections were compared between patients treated with tocilizumab (n = 55) and those who were not (n = 41).
More tocilizumab-treated patients required mechanical ventilation (44/55, 80%) compared to non-treated patients (15/41, 37%; P < 0.001). Of 55 patients treated with tocilizumab, 32 (58%) were on mechanical ventilation at the time of administration, and 12 (22%) progressed to mechanical ventilation after treatment. Of patients treated with tocilizumab requiring mechanical ventilation, 30/44 (68%) were intubated within 1 day of administration. Fewer deaths were observed among tocilizumab-treated patients, both in the overall population (15% vs 37%; P = 0.02) and among the subgroup of patients requiring mechanical ventilation (14% vs 60%; P = 0.001). Secondary infections were not different between the 2 groups (tocilizumab: 31%, non-tocilizumab: 17%; P = 0.16) and were predominantly related to invasive devices, such as urinary and central venous catheters.
Tocilizumab treatment was associated with fewer deaths compared to non-treatment despite predominantly being used in patients with more advanced respiratory disease.
在严重的 COVID-19 感染中观察到促炎细胞因子水平升高，细胞因子风暴与疾病严重程度相关。托珠单抗是一种白介素-6 受体拮抗剂，用于治疗嵌合抗原受体 T 细胞引起的细胞因子释放综合征，并可能减轻 COVID-19 中失调的免疫反应。我们比较了托珠单抗治疗和未用托珠单抗治疗的危重症 COVID-19 患者的结局。
设计、地点和参与者：这是一项回顾性观察性研究，在一家三级转诊中心进行，研究对象为 2020 年 3 月 1 日至 5 月 18 日期间因 COVID-19 入住重症监护病房且因死亡或出院而离开医院的所有患者（n = 96）。比较了接受托珠单抗治疗（n = 55）和未接受托珠单抗治疗（n = 41）的患者的死亡率和继发感染率。
与未治疗患者（15/41，37%；P < 0.001）相比，更多的托珠单抗治疗患者需要机械通气（44/55，80%）。55 例接受托珠单抗治疗的患者中，有 32 例（58%）在给药时接受机械通气，有 12 例（22%）在治疗后进展为机械通气。在接受托珠单抗治疗并需要机械通气的患者中，有 30/44（68%）在给药后 1 天内插管。托珠单抗治疗患者的死亡率较低，在总体人群中（15%比 37%；P = 0.02）和需要机械通气的亚组患者中（14%比 60%；P = 0.001）均如此。两组之间的继发感染无差异（托珠单抗组：31%，非托珠单抗组：17%；P = 0.16），且主要与侵入性装置相关，如导尿管和中心静脉导管。
尽管主要用于呼吸疾病更严重的患者，但与未治疗相比，托珠单抗治疗与死亡率降低相关。
