Mortality Predictors of Pre-variant SARS-CoV-2 Infected ARDS Patients Receiving Favipiravir and Tocilizumab

Abstract

In this study, viral clearance (oronasopharyngeal swab RT-PCR negativity) and intensive care outcomes and risk factors affecting mortality of critically ill patients with COVID-19-related acute respiratory distress syndrome (ARDS) who received tocilizumab and favipiravir treatments together before vaccination were investigated. The data of patients who were followed up and treated between 1 July 2020 and 5 October 2020 were retrospectively analyzed. Demographic data of the patients (age, gender), oro-nasopharyngeal swab RT-PCR and classification of ARDS, respiratory support treatments, all medical treatments, and ICU outcomes were recorded. Totally, 60 patients with a median age of 69.8 [24-87], 25 females and 35 males were included in the study. Mean APACHE II score was 18.9±8.0; and SOFA score was 4.5±2.0. Thirty-four (56.7%) patients were intubated during follow-up. Tocilizumab was given on average of 2.5th day (±2.0 days). On the day of tocilizumab administration, 1 (1.7%) patient had mild ARDS, 30 (50.0%) had moderate ARDS, 29 (48.3%) had severe ARDS. PaO2/FIO2 on the day of tocilizumab administration was 96.7±36.6 mmHg. Forty (66.7%) patients died, while 20 (33.3%) patients transferred to the service. The mean length of stay in the ICU was 11.4±5.5 days. Advanced age [Hazard ratio (HR) 1.8; 95% confidense interval (CI) 0.88-0.93; p< 0.001), higher APACHE II score (HR 0.81, 95% CI 0.74-0.98; p=0.001), higher SOFA score on the day of tocilizumab administration (HR 1.47, 95% CI 0.39-0.79; p=0.001), and lower PaO2/FIO2 ratio (HR 2.54, 95% CI 2.33-3.79; p<0.001) were determined as independent risk factors for mortality. Patients who were administered tocilizumab and favipiravir together in our intensive care unit were mostly patients with severe ARDS and had higher inflammatory markers. High mortality was attributed to the use of tocilizumab as an add-on treatment, not as a routine treatment.