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Multicenter Study
. 2022 Jun:107:108709.
doi: 10.1016/j.intimp.2022.108709. Epub 2022 Mar 18.

Predictors of poor outcome in tocilizumab treated patients with Sars-CoV-2 related severe respiratory failure: A multicentre real world study

Luca Masotti  1 , Giancarlo Landini  2 , Grazia Panigada  3 , Elisa Grifoni  4 , Roberto Tarquini  5 , Francesco Cei  5 , Barbara Maria Angela Cimolato  2 , Vieri Vannucchi  2 , Massimo Di Pietro  6 , Fiorella Piani  7 , Alberto Fortini  8 , Antonio Faraone  8 , Gabriele Nenci  9 , Franco Cipollini  10 , Pierluigi Blanc  11 , Pamela Lotti  12 , Massimo Di Natale  12 , Filippo Risaliti  12 , Donatella Aquilini  13 , Cristiana Seravalle  14 , Andrea Bribani  15 , Alessandro Farsi  16 , Irene Micheletti  4 , Elisa Cioni  4 , Giulia Pelagalli  4 , Chiara Mattaliano  4 , Gabriele Pinto  4 , Elisa Maria Madonia  4 , Irene Sivieri  4 , Marianna Mannini  4 , Alice Valoriani  5 , Simona Brancati  5 , Matteo Rosselli  5 , Eleonora Pavone  17 , Maria Chiara Burla  17 , Alessandro Sergi  18 ; Department of Medical Specialties of Azienda USL Toscana Centro Covid-19 Group
Affiliations
Multicenter Study

Predictors of poor outcome in tocilizumab treated patients with Sars-CoV-2 related severe respiratory failure: A multicentre real world study

Luca Masotti et al. Int Immunopharmacol. 2022 Jun.

Abstract

Introduction: Despite Tocilizumab is now recognized as a concrete therapeutic option in patients with severe SARS-CoV-2 related respiratory failure, literature lacks about factors influencing the response to it in this context. Therefore, the aim of our study was to provide evidence about predictors of poor outcome in Tocilizumab treated patients in the real-world practice.

Materials and methods: We retrospectively analyzed clinical, laboratory and chest computer tomography (CCT) data of patients firstly admitted in non Intensive Care Units (ICU) and suffering from severe respiratory failure, who were treated with the IL-6 antagonist Tocilizumab. We compared patients who died and/or required admission to ICU with oro-tracheal intubation (OTI) with those who did not.

Results: Two hundreds and eighty-seven patients (29.9% females) with mean age ± SD 64.1 ± 12.6 years were the study population. In-hospital mortality was 18.8%, while the composite endpoint in-hospital mortality and/or ICU admission with OTI occurred in 23.7%. At univariate analysis, patients who died and/or were admitted to ICU with OTI were significantly older and co-morbid, had significantly higher values of creatinine, C-reactive protein (CRP) and procalcitonin and lower lymphocytes count, PaO2/FiO2 ratio (P/F) and room air pulsossimetry oxygen saturation (RAO2S) at hospital admission. Computed tomography ground glass opacities (CT-GGO) involving the pulmonary surface ≥ 50% were found in 55.4% of patients who died and/or were admitted to ICU with OTI and in 21.5% of patients who did not (p=0.0001). At multivariate analysis, age ≥ 65 years (OR 17.3, 95% CI: 3.7-81.0), procalcitonin ≥ 0.14 (OR 9.9, 95%CI: 1.7-56.1), RAO2S ≤ 90% (OR 4.6, 95%CI: 1.2-17.0) and CCT-GGO involvement ≥ 50% (OR 5.1, 95%CI: 1.2-21.0) were independent risk factors associated with death and/or ICU admission with OTI.

Conclusion: Tocilizumab has shown to improve outcome in patients with severe respiratory failure associated to SARS-CoV-2 related pneumonia. In our multicentre study focusing on Tocilizumab treated severe COVID-19 patients, age ≥ 65 years, procalcitonin ≥ 0.14 ng/mL, RAO2S ≤ 90% and CCT-GGO involvement ≥ 50% were independent factors associated with poor outcome.

Keywords: COVID-19; Interleukin-6; Prognosis; Respiratory failure; SARS-CoV-2; Tocilizumab.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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