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. 2023 Jun 15;33(2):020704.
doi: 10.11613/BM.2023.020704.

Post-treatment neutrophil to lymphocyte ratio as a prognostic tool in patients treated with tocilizumab for severe COVID-19 pneumonia - a single center experience

Gomerčić Palčić Marija  1   2 , Matijaca Hana  3 , Kruljac Ivan  4 , Vusić Lucija  1 , Hostić Vedran  5 , Vrbanić Luka  2 , Fanika Mrsić  6 , Zrilić Radovan  7 , Ćelap Ivana  8 , Gaćina Petar  3   9
Affiliations

Post-treatment neutrophil to lymphocyte ratio as a prognostic tool in patients treated with tocilizumab for severe COVID-19 pneumonia - a single center experience

Gomerčić Palčić Marija et al. Biochem Med (Zagreb). .

Erratum in

Abstract

Introduction: Tocilizumab is used in patients with severe COVID-19 pneumonia and high concentration of IL-6. We studied potential prognostic role of neutrophil and lymphocyte count regarding tocilizumab treatment.

Materials and methods: We enrolled 31 patients with severe COVID-19 pneumonia and higher serum IL-6 concentration. The samples were taken on the day of tocilizumab administration and five days later. We used ROC analysis to investigate the association between the analysed parameters and 30-day mortality in order to determine the best pre-treatment and post-treatment prognostic factor. Kaplan-Meier curves and log-rank test were used to present and to analyse the difference in survival.

Results: Patients had a median age of 63 (55-67) years and were treated with a median tocilizumab dose of 800 mg. During the 30-day follow-up period, 17 patients died (30-day mortality 54%). Among pre-treatment variables, neutrophil count had the best prognostic accuracy (AUC 0.81, 95%CI: 0.65-0.96, P = 0.004), while neutrophil to lymphocyte ratio (NLR) had the highest accuracy among post-treatment variables in predicting 30-day mortality (AUC 0.94, 95%CI: 0.86-1.00, P < 0.001). Among post-treatment parameters, neutrophil count and NLR were equally good prognostic factors. Post-treatment NLR cut-off of 9.8 had the sensitivity of 81% and specificity of 93%. Patients with NLR ≥ 9.8 had the median survival of 7.0 (3-10) days vs. median survival not reached in patients with NLR < 9.8 (P < 0.001).

Conclusion: Pre-treatment and post-treatment neutrophil count with post-treatment NLR may represent prognostic tools for patients with higher IL-6 concentration in severe COVID-19 pneumonia treated with tocilizumab.

Keywords: COVID-19; interleukin-6; lymphocytes; neutrophils; tocilizumab.

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Conflict of interest statement

Potential conflict of interest None declared.

Figures

Figure 1
Figure 1
Kaplan-Meier curves showing the difference in survival based on pre-treatment neutrophil count (a) and post-treatment NLR (b). NLR – neutrophil to lymphocyte ratio.
See this image and copyright information in PMC

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