Mushtaq Muhammad Z, Mahmood Saad B Z, Almas Aysha, Ather Wasti Syed, Ahsan Ali Syed
Department of Medicine, The Aga Khan University Hospital, Stadium Road, Karachi, Pakistan.
Department of Medicine, The Aga Khan University Hospital, Stadium Road, Karachi, Pakistan.
Int Immunopharmacol. 2022 Jan;102:108384. doi: 10.1016/j.intimp.2021.108384. Epub 2021 Nov 20.
Tocilizumab decreases inflammatory response in the cytokine storm which is one of the mechanisms behind the development of ARDS in COVID-19 patients. The objective of our study was to determine response of tocilizumab in patients suffering from COVID-19 by analyzing clinical parameters and inflammatory markers. A single-arm observational retrospective study was conducted from March 15, 2020 to March 15, 2021. Clinical outcomes in terms of mortality, weaning from mechanical ventilator, improvement in laboratory parameters including inflammatory cytokines, and length of hospital stay were documented. Reduction in values of inflammatory markers, and patients discharged home in stable condition were defined as an improvement after tocilizumab administration. A total of 514 patients received tocilizumab, majority of whom were critically sick 333 (64.8%). Out of the total sample 363 (70.6%) patients were discharged home in stable condition. Overall mean length of stay was 11.50 ± 8.4 days. There was significant difference in length of stay of patients who required invasive mechanical ventilation as compared to those who were kept only on supplemental oxygen (p < 0.05). Patients who were discharged home showed significant improvement in inflammatory markers and neutrophil to lymphocyte ratio as compared to those who expired (p < 0.05). A total of 21 (4.1%) patients had positive blood culture while 57 (11.1%) had positive culture of tracheal aspirate. Hence, tocilizumab is found to be a reasonable therapeutic option for worsening COVID-19 pneumonia by decreasing the need for mechanical ventilation. However, it is associated with adverse events including bacterial and fungal infections.
托珠单抗可降低细胞因子风暴中的炎症反应，而细胞因子风暴是新冠病毒肺炎患者发生急性呼吸窘迫综合征（ARDS）的机制之一。我们研究的目的是通过分析临床参数和炎症标志物来确定托珠单抗对新冠病毒肺炎患者的疗效。2020年3月15日至2021年3月15日进行了一项单臂观察性回顾性研究。记录了死亡率、机械通气脱机情况、包括炎症细胞因子在内的实验室参数改善情况以及住院时间等临床结局。炎症标志物值降低以及患者病情稳定出院被定义为使用托珠单抗后的改善。共有514例患者接受了托珠单抗治疗，其中大多数病情危重，有333例（64.8%）。在全部样本中，363例（70.6%）患者病情稳定出院。总体平均住院时间为11.50±8.4天。与仅接受补充氧气治疗的患者相比，需要有创机械通气的患者住院时间有显著差异（p<0.05）。与死亡患者相比，出院患者的炎症标志物和中性粒细胞与淋巴细胞比值有显著改善（p<0.05）。共有21例（4.1%）患者血培养阳性，57例（11.1%）气管吸出物培养阳性。因此，发现托珠单抗通过减少机械通气需求，是治疗病情恶化的新冠病毒肺炎的一种合理治疗选择。然而，它与包括细菌和真菌感染在内的不良事件相关。
