The coronavirus disease 2019 (COVID-19) has caused a global pandemic, resulting in considerable morbidity and mortality. Tocilizumab, an inhibitor of IL-6, has been widely repurposed as a treatment of severely ill patients without robust evidence supporting its use. In this study, we aimed to systematically describe the effectiveness of treatment and prevention of the cytokine storms in COVID-19 patients with tocilizumab. In this multicentered retrospective and observational cohort study, 65 patients with COVID-19 receiving tocilizumab and 130 not receiving tocilizumab were propensity score matched at a ratio of 2:1 based on age, sex, and comorbidities from January 20, 2020 to March 18, 2020 in Wuhan, China. After adjusting for confounding, the detected risk for in-hospital death was lower in the tocilizumab group versus nontocilizumab group (hazard ratio = 0.47; 95% confidence interval = 0.25–0.90; p = 0.023). Moreover, use of tocilizumab was associated with a lower risk of acute respiratory distress syndrome (odds ratio = 0.23; 95% confidence interval = 0.11–0.45; p < 0.0001). Furthermore, patients had heightened inflammation and more dysregulated immune cells before treatment, which might aggravate disease progression. After tocilizumab administration, abnormally elevated IL-6, C-reactive protein, fibrinogen, and activated partial thromboplastin time decreased. Tocilizumab may be of value in prolonging survival in patients with severe COVID-19, which provided a novel strategy for COVID-19–induced cytokine release syndrome. Our findings could inform bedside decisions until data from randomized, controlled clinical trials become available.
Purpose Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are associated with polycythemia. However, there still remain unanswered questions about the relationship between overlap syndrome (OVS), where OSA and COPD coexist, and polycythemia. Here, we aimed to establish the prevalence of polycythemia in OVS patients and to explore the impact of OSA on polycythemia. Patients and Methods Patients with COPD underwent overnight polysomnography (PSG), pulmonary function tests, echocardiography, and complete blood counts. All patients were ethnic Han Chinese and free of prolonged oral corticosteroid use, hematological system disease, severe systemic disease, and other sleep-disordered breathing. OVS was defined as COPD patients with an apnea–hypopnea index ≥15 events/h, and polycythemia was defined as an Hb >165 g/L in men and >160 g/L in women. Results Eight-hundred and eighty-six patients with COPD were included in the analysis. The prevalence of polycythemia was significantly higher in OVS patients than COPD-alone patients (6.4% vs 2.9%, p < 0.05). The prevalence of polycythemia increased with OSA severity ( χ 2 = 7.885, p = 0.007), but not in GOLD grade 3–4 COPD patients ( χ 2 = 0.190, p = 0.663). After adjusting for confounders, percentage of total sleep time with SaO 2 <90% (TS 90 ) remained independently associated with an increased odds of polycythemia (OR 1.030, 95% CI 1.015–1.046) and, with an increase in TS 90 , the hemoglobin increased, especially in GOLD grade 1–2 patients ( p < 0.05). Conclusion Patients with OVS have a higher prevalence of polycythemia than those with COPD alone, and TS 90 is an independent factor for polycythemia, especially in GOLD1-2 COPD patients.
The aim of this study was to explain "obesity paradox" in chronic obstructive pulmonary disease (COPD) by evaluating the effect of body mass index (BMI) on lung function in Chinese patients with COPD. Methods: A total of 1644 patients diagnosed with COPD were recruited from four Chinese tertiary hospitals and were divided into four groups including underweight, normal weight, overweight and obese according to BMI classification standard. The medical data of these patients were collected and used for the multiple linear regression analyses. Results: After adjustment for age, sex, educational level, economic status, smoking status, alcohol consumption, duration of COPD history, events of acute exacerbation in previous year, hypertension, diabetes mellitus, cardiovascular disease, cerebrovascular disease and osteoporosis, BMI had a curvilinear correlation with the forced expiratory volume in the first second (FEV 1) in patients with Global Initiative for Obstructive Lung Disease (GOLD) 1-2 grade (first-order coefficient β, 0.09; 95% CI, 0.03-0.16; second-order coefficient β, −0.002; 95% CI, −0.003-0.001; P<0.01). However, BMI had a positive correlation with FEV 1 in patients with GOLD 3-4 grade (β, 0.01; 95% CI, 0.008-0.017; P<0.01) when BMI was used as a quantitative variable. When BMI was used as a qualitative variable, only FEV 1 in overweight group with GOLD 1-2 grade was significantly higher than that of normal weight group (P<0.01). Interestingly, both overweight and obese groups had higher FEV 1 in GOLD 3-4 grade compared with normal weight group (β, 0.06; 95% CI, 0.02-0.11; β, 0.11; 95% CI, 0.04-0.18; P<0.01). The effect of BMI on predicted percentage of FEV 1 (FEV 1 %) was similar to that of FEV 1 in different GOLD grades. Conclusion: Obesity only had a protective effect on lung function in COPD patients with GOLD 3-4 grade rather than GOLD 1-2 grade.
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