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Randomized Controlled Trial
. 2021 Apr 23;11(1):8816.
doi: 10.1038/s41598-021-88086-x.

Short term survival of critically ill COVID-19 Egyptian patients on assisted ventilation treated by either Dexamethasone or Tocilizumab

Alaa Rashad  1 , Sherif Mousa  2 , Hanaa Nafady-Hego  3 , Asmaa Nafady  4   5 , Hamed Elgendy  6   7
Affiliations
Randomized Controlled Trial

Short term survival of critically ill COVID-19 Egyptian patients on assisted ventilation treated by either Dexamethasone or Tocilizumab

Alaa Rashad et al. Sci Rep. .

Abstract

Tocilizumab (TCZ) and Dexamethasone are used for the treatment of critically ill COVID-19 patients. We compared the short-term survival of critically ill COVID-19 patients treated with either TCZ or Dexamethasone. 109 critically ill COVID-19 patients randomly assigned to either TCZ therapy (46 patients) or pulse Dexamethasone therapy (63 patients). Age, sex, neutrophil/ lymphocyte ratio, D-dimer, ferritin level, and CT chest pattern were comparable between groups. Kaplan-Meier survival analysis showed better survival in Dexamethasone group compared with TCZ (P = 0.002), patients didn't need vasopressor at admission (P < 0.0001), patients on non-invasive ventilation compared to patients on mechanical ventilation (P<0.0001 ), and in patients with ground glass pattern in CT chest (P<0.0001 ) compared with those who have consolidation. Cox regression analysis showed that, TCZ therapy (HR = 2.162, 95% CI, 1.144-4.087, P <0.0001) compared with Dexamethasone group, higher neutrophil/Lymphocyte ratio (HR = 2.40, CI, 1.351-4.185, P = 0.003), lower PaO2/FiO2, 2 days after treatment, (HR = 1.147, 95% CI, 1.002-1.624, P < 0.0001) independently predicted higher probability of mortality. Dexamethasone showed better survival in severe COVID-19 compared to TCZ. Considering the risk factors mentioned here is crucial when dealing with severe COVID-19 cases.Clinical trial registration No clinicalTrials.gov: Nal protocol approved by Hospital Authorities, for data collection and for participation in CT04519385 (19/08/2020).

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Showed PaO2/FiO2 variations after exposure of infected patients with COVID-19 to either tocilizumab or pulse Dexamethasone therapy. P ˂ 0.05 considered statistically significant.
Figure 3
Figure 3
Showed Kaplan–Meier survival curve of critically ill COVID-19 patients, (A) for patients who received Toclizumab compared to those received pulse Dexamethasone (P = 0.002). (B) for patients with CT Chest showing Ground glass opacities (GGO) compared with bilateral consolidation, (P < 0.0001). (C) patients who do not need vasopressors at admission and those who need vasopressors at admission (P < 0.0001). (D) patients on mechanical ventilation compared to those on Non-invasive ventilation (P < 0.0001).
See this image and copyright information in PMC

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