托珠单抗治疗重症和危重症 COVID-19 患者的死亡率的影响：三级医疗中心的经验。

Effect of Tocilizumab in Mortality among Patients with Severe and Critical Covid-19: Experience in a Third-Level Medical Center.

机构信息

Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.

Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.

出版信息

Rev Invest Clin. 2022 Jan 3;74(1):40-50. doi: 10.24875/RIC.21000404.

DOI:10.24875/RIC.21000404

PMID:34618802

Abstract

BACKGROUND

Trials evaluating safety and efficacy of tocilizumab in coronavirus disease 19 (COVID-19) show contradictory results.

OBJECTIVE

The objective of the study was to evaluate the effect of tocilizumab in hospital mortality among patients with severe COVID-19 in a third-level medical center.

METHODS

This prospective cohort study included patients with severe and critical COVID-19. Primary outcome was death during hospitalization. Secondary outcomes included invasive mechanical ventilation (IMV), days on IMV, ventilator-free days (VFDs), length of hospital stay (LOS), and development of hospitalacquired infections (HAIs). Bivariate, multivariate, and propensity score matching analysis were performed.

RESULTS

During the study period, 99/794 (12%) patients received tocilizumab. Male patients, health care workers, and patients with increased inflammatory markers received tocilizumab more frequently. No difference in hospital mortality was observed between groups (34% vs. 34%, p = 0.98). Tocilizumab was not independently associated with mortality. No significant treatment effects were observed in propensity score analysis. IMV was more frequent (46% vs. 11%, p < 0.01) and LOS was longer (12 vs. 7 days, p < 0.01) in the tocilizumab group, reflecting increased severity. Although HAIs were more frequent in the tocilizumab group (22% vs. 10%, p < 0.01), no difference was seen after adjusting for IMV (38% vs. 40%, p = 0.86).

CONCLUSIONS

In our study, tocilizumab was not associated with decreased hospital mortality among patients with severe COVID-19.

摘要

背景

评估托珠单抗在 2019 年冠状病毒病（COVID-19）中的安全性和疗效的试验结果相互矛盾。

目的

本研究旨在评估托珠单抗在三级医疗中心的重症 COVID-19 患者中的住院死亡率的影响。

方法

这是一项前瞻性队列研究，纳入了重症和危重症 COVID-19 患者。主要结局是住院期间的死亡。次要结局包括有创机械通气（IMV）、IMV 天数、无通气天数（VFDs）、住院时间（LOS）和医院获得性感染（HAIs）的发展。进行了单变量、多变量和倾向评分匹配分析。

结果

在研究期间，99/794（12%）例患者接受了托珠单抗治疗。男性患者、医务人员和炎症标志物升高的患者更频繁地接受托珠单抗治疗。两组之间的住院死亡率无差异（34%比 34%，p=0.98）。托珠单抗与死亡率无独立相关性。倾向评分分析未观察到显著的治疗效果。托珠单抗组更频繁地使用有创机械通气（46%比 11%，p<0.01），且 LOS 更长（12 天比 7 天，p<0.01），表明病情更严重。尽管托珠单抗组的医院获得性感染更频繁（22%比 10%，p<0.01），但在调整有创机械通气后无差异（38%比 40%，p=0.86）。