细胞因子阻断剂对因感染SARS-CoV-2而入住重症监护病房的急性呼吸窘迫综合征患者医院死亡率的影响：回顾性队列研究。
Effects of cytokine blocking agents on hospital mortality in patients admitted to ICU with acute respiratory distress syndrome by SARS-CoV-2 infection: retrospective cohort study.
作者信息
Coloretti Irene, Busani Stefano, Biagioni Emanuela, Venturelli Sophie, Munari Elena, Sita Marco, DallAra Lorenzo, Tosi Martina, Clini Enrico, Tonelli Roberto, Fantini Riccardo, Mussini Cristina, Meschiari Marianna, Guaraldi Giovanni, Cossarizza Andrea, Alfano Gaetano, Girardis Massimo
机构信息
Intensive Care Unit, University Hospital of Modena.
Respiratory Disease Unit, University Hospital of Modena.
出版信息
Multidiscip Respir Med. 2021 May 17;16(1):737. doi: 10.4081/mrm.2021.737. eCollection 2021 Jan 15.
BACKGROUND
The use of cytokine-blocking agents has been proposed to modulate the inflammatory response in patients with COVID-19. Tocilizumab and anakinra were included in the local protocol as an optional treatment in critically ill patients with acute respiratory distress syndrome (ARDS) by SARS-CoV-2 infection. This cohort study evaluated the effects of therapy with cytokine blocking agents on in-hospital mortality in COVID-19 patients requiring mechanical ventilation and admitted to intensive care unit.
METHODS
The association between therapy with tocilizumab or anakinra and in-hospital mortality was assessed in consecutive adult COVID-19 patients admitted to our ICU with moderate to severe ARDS. The association was evaluated by comparing patients who received to those who did not receive tocilizumab or anakinra and by using different multivariable Cox models adjusted for variables related to poor outcome, for the propensity to be treated with tocilizumab or anakinra and after patient matching.
RESULTS
Sixty-six patients who received immunotherapy (49 tocilizumab, 17 anakinra) and 28 patients who did not receive immunotherapy were included. The in-hospital crude mortality was 30,3% in treated patients and 50% in nontreated (OR 0.77, 95% CI 0.56-1.05, p=0.069). The adjusted Cox model showed an association between therapy with immunotherapy and in-hospital mortality (HR 0.40, 95% CI 0.19-0.83, p=0.015). This protective effect was further confirmed in the analysis adjusted for propensity score, in the propensity-matched cohort and in the cohort of patients with invasive mechanical ventilation within 2 hours after ICU admission.
CONCLUSIONS
Although important limitations, our study showed that cytokine-blocking agents seem to be safe and to improve survival in COVID-19 patients admitted to ICU with ARDS and the need for mechanical ventilation.
背景
有人提出使用细胞因子阻断剂来调节新型冠状病毒肺炎（COVID-19）患者的炎症反应。托珠单抗和阿那白滞素被纳入当地方案，作为严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染所致急性呼吸窘迫综合征（ARDS）危重症患者的一种可选治疗方法。这项队列研究评估了细胞因子阻断剂治疗对需要机械通气并入住重症监护病房的COVID-19患者院内死亡率的影响。
方法
在连续入住我们重症监护病房的中度至重度ARDS成年COVID-19患者中，评估托珠单抗或阿那白滞素治疗与院内死亡率之间的关联。通过比较接受和未接受托珠单抗或阿那白滞素治疗的患者，并使用不同的多变量Cox模型进行评估，这些模型针对与不良预后相关的变量、接受托珠单抗或阿那白滞素治疗的倾向以及患者匹配后进行了调整。
结果
纳入了66例接受免疫治疗的患者（49例接受托珠单抗，17例接受阿那白滞素）和28例未接受免疫治疗的患者。接受治疗患者的院内粗死亡率为30.3%，未接受治疗患者为50%（比值比0.77，95%置信区间0.56 - 1.05，p = 0.069）。调整后的Cox模型显示免疫治疗与院内死亡率之间存在关联（风险比0.40，95%置信区间0.19 - 0.83，p = 0.015）。在倾向评分调整分析、倾向匹配队列以及入住重症监护病房后2小时内进行有创机械通气的患者队列中，这种保护作用得到了进一步证实。
结论
尽管存在重要局限性，但我们的研究表明，细胞因子阻断剂似乎对入住重症监护病房且患有ARDS并需要机械通气的COVID-19患者是安全的，并能提高生存率。
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