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. 2022 Nov-Dec:56:118-124.
doi: 10.1016/j.hrtlng.2022.06.024. Epub 2022 Jun 30.

"Ventilator-free days" composite outcome in patients with SARS-CoV-2 infection treated with tocilizumab: A retrospective competing risk analysis

Ahmed F Mady  1 , Basheer Abdulrahman  2 , Shahzad A Mumtaz  2 , Mohammed A Al-Odat  2 , Ahmed Kuhail  2 , Rehab Altoraifi  2 , Rayan Alshae  2 , Abdulrahman M Alharthy  2 , Waleed Th Aletreby  3
Affiliations

"Ventilator-free days" composite outcome in patients with SARS-CoV-2 infection treated with tocilizumab: A retrospective competing risk analysis

Ahmed F Mady et al. Heart Lung. 2022 Nov-Dec.

Abstract

Background: SARS-CoV-2 infection demonstrates a wide range of severity, with more severe cases presenting with a cytokine storm with elevated serum interleukin-6; hence, the interleukin-6 receptor antibody tocilizumab was used for the management of severe cases.

Objective: To explore the effect of tocilizumab on ventilator-free day composite outcomes among critically ill patients with SARS-CoV-2 infection.

Methods: This retrospective propensity score-matching study compared mechanically ventilated patients who received tocilizumab to a control group.

Results: Twenty-nine patients in the intervention group were compared to 29 controls. The matched groups were similar. The ventilator-free days composite outcome was higher in the intervention group (sub-distribution hazard ratio 2.7, 95% confidence interval [CI]: 1.2-6.3; p = 0.02), the mortality rate in the intensive care unit was not different (37.9% vs 62%, p = 0.1), and actual ventilator-free days were significantly longer in the tocilizumab group (mean difference 4.7 days; p = 0.02). Sensitivity analysis showed a significantly lower hazard ratio for death in the tocilizumab group (HR 0.49, 95% CI: 0.25-0.97; p = 0.04). Positive cultures were not significantly different among the groups (55.2% vs 34.5% in the tocilizumab and control groups, respectively; p = 0.1).

Conclusions: Tocilizumab may improve the composite outcome of ventilator-free days at day 28 among mechanically ventilated patients with SARS-CoV-2 infection. It is associated with significantly longer actual ventilator-free days, insignificantly lower mortality, and higher superinfection.

Keywords: Mechanical ventilation; SARS-CoV-2; Tocilizumab; Ventilator-free days.

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Conflict of interest statement

Declaration of Competing Interest Nothing to declare.

Figures

Fig 1
Fig. 1
Patients’ and study groups’ flow diagram: Flow diagram of included and excluded patients in the study, and matched groups.
Fig 2
Fig. 2
Kaplan Meier survival curve: Survival of patients in both groups up to 28 days, evaluated by Log – Rank test showing significant difference (p = 0.04).
See this image and copyright information in PMC

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