Ercan Selin, Ergan Begüm, Özuygur Saliha Selin, Korkmaz Pervin, Taşbakan Mehmet Sezai, Basoglu Özen K, Kerget Buğra, Akgün Metin, Elbek Osman, Sayıner Abdullah, Kılınç Oğuz
Department of Pulmonology Medicine, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey.
Department of Pulmonology Medicine, Faculty of Medicine, Ege University, İzmir, Turkey.
Turk Thorac J. 2022 May;23(3):225-230. doi: 10.5152/TurkThoracJ.2022.21179.
A substantial number of patients with coronavirus disease-2019 (COVID-19) demonstrate severe infection. Cytokine storm is an underlying condition that worsens clinical outcomes. As an interleukin-6 receptor antagonist, tocilizumab is a promising treatment option for COVID-19. This study aimed to evaluate the clinical predictors of mortality for critically ill COVID-19 patients receiving tocilizumab therapy.
The retrospective cohort study was conducted in 4 centers' both wards and intensive care units between March 20 and May 20, 2020. Demographic, clinical, and laboratory data were consecutively drawn from medical records. The primary endpoint was in-hospital mortality.
In this study, 39 patients (28.2% female) were included, and the mortality rate was 25.6% (n = 10). There was statistically significant difference between survivor and non-survivor groups regarding age (53.0 (46.5-65.0) vs. 75.0 (68.25-81.25), respectively,P = .001), CALL score (8.0 (7.0-10.0) vs. 12.0 (9.75-13.0), P = .001), GRAM score (119.5 (99.5-142.0) vs. 155.0 (129.8-226.0), P = .004), and white blood cell count (k/mL) (5.6 (3.8-8.6) vs. 8.0 (7.6-9.3), P = .003). The patients who were on invasive mechanical ventilation at the time of tocilizumab administration had a higher mortality rate (100% vs. 25.9%, P < .001). Besides, arterial partial pressure of oxygen/ fraction of inspiratory oxygen (PaO2/FiO2) ratio on day 7, but not on days 0, 1, and 3 of tocilizumab therapy, was associated with mortal- ity. C-reactive protein (mg/dL) tended to be lower in the survivor group; however, it was not statistically significant (68.4 (32.7-157.5) vs. 113.5 (77.7-219.0), P = .058).
This study demonstrated that advanced age, increased leukocyte count, higher CALL and GRAM scores, and the need for invasive mechanical ventilation revealed a worse prognosis after tocilizumab treatment.
大量2019冠状病毒病（COVID-19）患者表现出严重感染。细胞因子风暴是一种会使临床结局恶化的潜在病症。作为一种白细胞介素-6受体拮抗剂，托珠单抗是一种有前景的COVID-19治疗选择。本研究旨在评估接受托珠单抗治疗的重症COVID-19患者的死亡临床预测因素。
这项回顾性队列研究于2020年3月20日至5月20日在4个中心的病房和重症监护病房进行。人口统计学、临床和实验室数据连续从病历中提取。主要终点是住院死亡率。
本研究纳入了39例患者（女性占28.2%），死亡率为25.6%（n = 10）。幸存者和非幸存者组在年龄（分别为53.0（46.5 - 65.0）和75.0（68.25 - 81.25），P = .001）、CALL评分（8.0（7.0 - 10.0）和12.0（9.75 - 13.0），P = .001）、GRAM评分（119.5（99.5 - 142.0）和155.0（129.8 - 226.0），P = .004）以及白细胞计数（k/mL）（5.6（3.8 - 8.6）和8.0（7.6 - 9.3），P = .003）方面存在统计学显著差异。在给予托珠单抗时接受有创机械通气的患者死亡率更高（100%对25.9%，P < .001）。此外，托珠单抗治疗第7天的动脉血氧分压/吸入氧分数（PaO₂/FiO₂）比值与死亡率相关，而在第0、1和3天则不然。幸存者组的C反应蛋白（mg/dL）趋于更低；然而，差异无统计学意义（68.4（32.7 - 157.5）对113.5（77.7 - 219.0），P = .058）。
本研究表明，高龄、白细胞计数增加、CALL和GRAM评分更高以及需要有创机械通气提示托珠单抗治疗后的预后较差。
