Use of tocilizumab in COVID-19 pneumonia hospitalized patients. Cohort study

Abstract

Introduction

In COVID 19, an aggressive inflammatory response called cytokine release storm has been described. It is mainly mediated by the activation of Interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α), mainly observed in critically ill patients. Among the multiple treatments proposed throughout these two years of pandemic, we highlight the use of Tocilizumab (TCZ).

Objectives

To evaluate in-hospital mortality, transfer to critical care unit (CCU), invasive mechanical ventilation requirement (IMV), and hospital stay in patients treated with TCZ versus conventional treatments (CT).

Methods

Retrospective, descriptive, and analytical cohort study. Hospitalized patients, May to July 2021. Branches: treated with TCZ versus CT. Statistical analysis: Epi Info 7.2.

Results

Ninety patients, 51 TCZ branch and 39 CT branch. Age 48.2 years (± 11.7), males 74 (82.2%). Comorbidities 66 (73.3%): High blood pressure (HBP) 32 (35.6%), Diabetes mellitus 13 (14.4%), BMI > 30, 51 (56.7%). Medical Clinic Admission (MC) 85 (94.4%). Days post-symptom onset 7.9 (± 2.6). Severity of COVID 19: severe 61 (67.8%), critical 26 (28.9%). CCU admission 26 (29.9%). IMV 16 (17.8%). Deaths 7 (7.9%). Hospital stay 12.9 (± 6.6) days. Comparative analysis TCZ versus CT: MC admission 50 (98%) versus 35 (89.7%) p .08. CCU admission 12 (23.5%) versus 14 (38.9%) p .1. IMV 4 (7.8%) versus 12 (30.8%) p .005. Death 1 (2.0%) versus 6 (15.8%) p .02. Mortality in univariate analysis (p < .05): APACHE II, BMI > 30, TCZ, IMV, and CCU admission. TCZ was a protective factor against RR of death .86 (.74–.99). The IMV requirement was a RR factor for death 2.0 (1.23–3.42). Cox logistic regression, independent survival factors: use of TCZ, absence of obesity, and no IMV, p .0000.

Conclusions

IMV was found to be a risk factor for mortality. TCZ did not show a decrease in CCU requirement, but it did prove to be a protective factor against mortality. However, this is a non-randomized study so it should be interpreted with caution.