Clinical characteristics and predictors of survival in adults with coronavirus disease 2019 receiving tocilizumab

Abstract

Coronavirus disease 2019 (COVID-19) can progress to cytokine storm that is associated with organ dysfunction and death. The purpose of the present study is to determine clinical characteristics associated with 28 day inhospital survival in patients with coronavirus disease 2019 (COVID-19) that received tocilizumab. This was a retrospective observational cohort study conducted at a five hospital health system in Michigan, United States. Adult patients with confirmed COVID-19 that were admitted to the hospital and received tocilizumab for cytokine storm from March 1, 2020 through April 3, 2020 were included. Patients were grouped into survivors and non-survivors based on 28 day in-hospital mortality. Study day 0 was defined as the day tocilizumab was administered. Factors independently associated with in-hospital survival at 28 days after tocilizumab administration were assessed. Epidemiologic, demographic, laboratory, prognostic scores, treatment, and outcome data were collected and analyzed. Clinical response was collected and defined as a decline of two levels on a six-point ordinal scale of clinical status or discharged alive from the hospital. Of the 81 patients included, the median age was 64 (58-71) years and 56 (69.1%) were male. The 28 day in-hospital mortality was 43.2%. There were 46 (56.8%) patients in the survivors and 35 (43.2%) in the non-survivors group. On study day 0 no differences were noted in demographics, clinical characteristics, severity of illness scores, or treatments received between survivors and non-survivors. C-reactive protein was significantly higher in the non-survivors compared to survivors. Compared to non-survivors, recipients of tocilizumab within 12 days of symptom onset was independently associated with survival (adjusted OR: 0.296, 95% CI: 0.098-0.889). SOFA score ≥8 on day 0 was independently associated with mortality (adjusted OR: 2.842, 95% CI: 1.042-7.753). Clinical response occurred more commonly in survivors than non-survivors (80.4% vs. 5.7%; p < 0.001). Improvements in the six-point ordinal scale and SOFA score were observed in survivors after tocilizumab. Early receipt of tocilizumab in patients with severe COVID-19 was an independent predictor for in-hospital survival at 28 days.

Rheumatic Musculoskeletal Diseases and COVID-19 A Review of the First 6 Months of the Pandemic

“…Of these, Campochiaro et al and Canziani et al did not find a statistically reduced mortality in tocilizumab treated patients, although both studies showed a respective trend ( 121 , 122 ) additionally, tocilizumab treated patients required invasive ventilation statistically less frequently than controls ( 122 ). In line with this observation the outcomes of several studies suggest that patients may benefit most from tocilizumab if given before invasive ventilation ( 125 , 127 ). In a prospective open single-arm study investigating 63 COVID-19 patients with signs of CRS, administering tocilizumab within the first 6 days of hospitalization was associated with a better outcome than later in the course of disease, irrespective of the intravenous or subcutaneous route of administration ( 128 ).…”

Diabetes Mellitus is Associated with Severe Infection and Mortality in Patients with COVID-19: A Systematic Review and Meta-analysis

“…The flow of studies through our meta-analysis is depicted in Figure 1 . A total of 76 studies with 31,067 patients were eventually included in our study ( 8 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , ...…”

Influenza infection, SARS, MERS and COVID-19: Cytokine storm – The common denominator and the lessons to be learned

“…However, in a recent study it was shown that patients with COVID-19 on non-invasive ventilation treated with tocilizumab require invasive ventilation significantly less frequently than controls [ 89 ]. In another study early receipt of tocilizumab (within 12 days of symptom onset) in patients with severe COVID-19 was the only factor independently associated with in-hospital survival at 28 days [ 90 ]. These findings further support the early anti-IL6 treatment in an appropriate group of patients with COVID-19.…”