Infectious Diseases Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain; International Health Program of the Catalan Institut of Health (PROSICS), Barcelona, Spain; Tropical Medicine Spanish Research Network (RICET), Madrid, Spain.
Infectious Diseases Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
Med Clin (Barc). 2022 Jun 10;158(11):509-518. doi: 10.1016/j.medcli.2021.06.012. Epub 2021 Jun 18.
Modulation of the immune system to prevent lung injury is being widely used against the new coronavirus disease (COVID-19). The primary endpoint was mortality at 7 days after tocilizumab administration. Secondary endpoints were admission to the intensive care unit, development of ARDS and respiratory insufficiency among others.
We report the preliminary results from the Vall d'Hebron cohort study at Vall d'Hebron University Hospital, in Barcelona (Spain), including all consecutive patients who had a confirmed SARS-CoV-2 infection and who were treated with tocilizumab until March 25th.
82 patients with COVID-19 received at least one dose of tocilizumab. The mean (± SD) age was 59.1 (19.8) years, 63% were male, 22% were of non-Spanish ancestry, and the median (IQR) age-adjusted Charlson index at baseline was 3 (1-4) points. Respiratory failure and ARDS developed in 62 (75.6%) and 45 (54.9%) patients, respectively. Median time from symptom onset to ARDS development was 8 (5-11) days. Mortality at 7 days was 26.8%. Hazard ratio for mortality was 3.3; 95% CI, 1.3-8.5 (age-adjusted hazard ratio for mortality 2.1; 95% CI, 0.8-5.8) if tocilizumab was administered after the onset of ARDS.
Early administration of tocilizumab in patients needing oxygen supplementation may be critical to patient recovery. Our preliminary data could inform bedside decisions until more data regarding the precise timing in of initiation of the treatment with tocilizumab.
为预防新型冠状病毒病（COVID-19）导致的肺部损伤，人们广泛采用调节免疫系统的方法。主要终点为托珠单抗给药后 7 天的死亡率。次要终点包括入住重症监护病房、发生急性呼吸窘迫综合征和呼吸功能不全等。
我们报告了巴塞罗那 Vall d'Hebron 大学医院 Vall d'Hebron 队列研究的初步结果，该研究纳入了所有确诊为 SARS-CoV-2 感染且接受托珠单抗治疗的连续患者，直至 2020 年 3 月 25 日。
82 例 COVID-19 患者至少接受了一剂托珠单抗治疗。患者的平均（±SD）年龄为 59.1（19.8）岁，63%为男性，22%是非西班牙裔，基线时年龄调整 Charlson 指数中位数（IQR）为 3（1-4）分。62 例（75.6%）和 45 例（54.9%）患者分别发生呼吸衰竭和急性呼吸窘迫综合征。从症状发作到急性呼吸窘迫综合征发生的中位时间为 8（5-11）天。7 天死亡率为 26.8%。死亡风险比为 3.3；95%CI1.3-8.5（年龄调整后死亡率风险比为 2.1；95%CI0.8-5.8），如果在急性呼吸窘迫综合征发生后开始使用托珠单抗。
在需要吸氧的患者中早期给予托珠单抗可能对患者康复至关重要。我们的初步数据可以为床边决策提供信息，直到获得更多关于开始托珠单抗治疗的确切时机的详细数据。
