Kılıç Özlem, Tecer Duygu, Kaya Mehmet Nur, Çınar Muhammet, Yılmaz Sedat
Department of Rheumatology, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, Türkiye.
Department of Rheumatology, Hakkari State Hospital, Hakkari, Türkiye.
Eur J Rheumatol. 2025 Apr 16;12(1):1-6. doi: 10.5152/eurjrheum.2025.24048.
The aim of this study is to assess the effectiveness of the Early Warning Score [ANDC (age (A), neutrophil-to-lymphocyte ratio (NLR (N)), D-dimer (D), and CRP (C)] in predicting the treatment response in patients receiving tocilizumab for Coronavirus Disease 2019 (COVID-19)-related cytokine storm.
A retrospective review of medical records was conducted for patients treated with tocili- zumab for a cytokine storm related to COVID-19 between April 1, 2020, and April 1, 2021. Patient demographics, clinical characteristics, and laboratory parameters within 24 hours before tocilizumab were recorded. 1.14 × (age - 20) (years) + 1.63 × NLR + 5.00 × D-dimer (mg/L) + 0.14 × C-reactive protein (CRP) (mg/L) was used as the formula for the ANDC score. The study population was divided into 2 groups: those who died within 28 days of receiving tocilizumab and those who recovered. A comparative analysis was conducted.
Within 28 days of tocilizumab treatment, 59 (35.32%) patients died. In comparison with living patients, deceased patients exhibited considerably higher levels of interleukin (IL)-6, lactate dehydro- genase (LDH), ANDC score, and CRP (P < .05). Lactate dehydrogenase was an independent predictor of response to tocilizumab treatment (P < .001) in a multivariate logistic regression analysis. In patients who did not receive steroid therapy before tocilizumab treatment, the ANDC score had the highest area under the curve (AUC). The optimal cut-off value was determined to be 92.56, with a sensitivity of 91.67% and a specificity of 60.61% (P < .001). In patients receiving steroids before tocilizumab, LDH had the highest AUC. The optimal cut-off value was 484.5 U/L (P < .001).
Lactate dehydrogenase was identified as an independent predictor of response to tocili- zumab treatment. The ANDC score showed the highest AUC value in steroid-naïve patients before tocilizumab, whereas LDH showed the highest AUC value in patients receiving steroids before tocili- zumab. Both the ANDC score and LDH levels show potential as valuable tools to guide treatment decisions.
本研究旨在评估早期预警评分[ANDC（年龄（A）、中性粒细胞与淋巴细胞比值（NLR（N））、D-二聚体（D）和C反应蛋白（C）]在预测接受托珠单抗治疗2019冠状病毒病（COVID-19）相关细胞因子风暴患者的治疗反应中的有效性。
对2020年4月1日至2021年4月1日期间接受托珠单抗治疗COVID-19相关细胞因子风暴的患者的病历进行回顾性分析。记录托珠单抗治疗前24小时内的患者人口统计学特征、临床特征和实验室参数。使用1.14×（年龄-20）（岁）+1.63×NLR+5.00×D-二聚体（mg/L）+0.14×C反应蛋白（CRP）（mg/L）作为ANDC评分公式。研究人群分为两组：在接受托珠单抗治疗后28天内死亡的患者和康复的患者。进行了对比分析。
在托珠单抗治疗的28天内，59例（35.32%）患者死亡。与存活患者相比，死亡患者的白细胞介素（IL）-6、乳酸脱氢酶（LDH）、ANDC评分和CRP水平显著更高（P<.05）。在多因素逻辑回归分析中，乳酸脱氢酶是托珠单抗治疗反应的独立预测因子（P<.001）。在托珠单抗治疗前未接受类固醇治疗的患者中，ANDC评分的曲线下面积（AUC）最高。确定最佳截断值为92.56，敏感性为91.67%，特异性为60.61%（P<.001）。在托珠单抗治疗前接受类固醇治疗的患者中，LDH的AUC最高。最佳截断值为484.5 U/L（P<.001）。
乳酸脱氢酶被确定为托珠单抗治疗反应的独立预测因子。在托珠单抗治疗前未使用过类固醇的患者中，ANDC评分的AUC值最高，而在托珠单抗治疗前接受类固醇治疗的患者中，LDH的AUC值最高。ANDC评分和LDH水平都显示出作为指导治疗决策的有价值工具的潜力。
