Özlem Kılıç, Duygu Tecer, Mehmet Nur Kaya, Muhammet Çınar, Sedat Yılmaz
{"title":"早期预警评分（ANDC）能否预测Tocilizumab对COVID-19细胞因子风暴患者的疗效？","authors":"Özlem Kılıç, Duygu Tecer, Mehmet Nur Kaya, Muhammet Çınar, Sedat Yılmaz","doi":"10.5152/eurjrheum.2025.24048","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The aim of this study is to assess the effectiveness of the Early Warning Score [ANDC (age (A), neutrophil-to-lymphocyte ratio (NLR (N)), D-dimer (D), and CRP (C)] in predicting the treatment response in patients receiving tocilizumab for Coronavirus Disease 2019 (COVID-19)-related cytokine storm.</p><p><strong>Methods: </strong>A retrospective review of medical records was conducted for patients treated with tocili- zumab for a cytokine storm related to COVID-19 between April 1, 2020, and April 1, 2021. Patient demographics, clinical characteristics, and laboratory parameters within 24 hours before tocilizumab were recorded. 1.14 × (age - 20) (years) + 1.63 × NLR + 5.00 × D-dimer (mg/L) + 0.14 × C-reactive protein (CRP) (mg/L) was used as the formula for the ANDC score. The study population was divided into 2 groups: those who died within 28 days of receiving tocilizumab and those who recovered. A comparative analysis was conducted.</p><p><strong>Results: </strong>Within 28 days of tocilizumab treatment, 59 (35.32%) patients died. In comparison with living patients, deceased patients exhibited considerably higher levels of interleukin (IL)-6, lactate dehydro- genase (LDH), ANDC score, and CRP (P < .05). Lactate dehydrogenase was an independent predictor of response to tocilizumab treatment (P < .001) in a multivariate logistic regression analysis. In patients who did not receive steroid therapy before tocilizumab treatment, the ANDC score had the highest area under the curve (AUC). The optimal cut-off value was determined to be 92.56, with a sensitivity of 91.67% and a specificity of 60.61% (P < .001). In patients receiving steroids before tocilizumab, LDH had the highest AUC. The optimal cut-off value was 484.5 U/L (P < .001).</p><p><strong>Conclusion: </strong>Lactate dehydrogenase was identified as an independent predictor of response to tocili- zumab treatment. The ANDC score showed the highest AUC value in steroid-naïve patients before tocilizumab, whereas LDH showed the highest AUC value in patients receiving steroids before tocili- zumab. Both the ANDC score and LDH levels show potential as valuable tools to guide treatment decisions.</p>","PeriodicalId":12066,"journal":{"name":"European journal of rheumatology","volume":"12 1","pages":"1-6"},"PeriodicalIF":1.3000,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060182/pdf/","citationCount":"0","resultStr":"{\"title\":\"Can the Early Warning Score (ANDC) Predict Tocilizumab Efficacy in Patients with COVID-19 Cytokine Storm?\",\"authors\":\"Özlem Kılıç, Duygu Tecer, Mehmet Nur Kaya, Muhammet Çınar, Sedat Yılmaz\",\"doi\":\"10.5152/eurjrheum.2025.24048\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The aim of this study is to assess the effectiveness of the Early Warning Score [ANDC (age (A), neutrophil-to-lymphocyte ratio (NLR (N)), D-dimer (D), and CRP (C)] in predicting the treatment response in patients receiving tocilizumab for Coronavirus Disease 2019 (COVID-19)-related cytokine storm.</p><p><strong>Methods: </strong>A retrospective review of medical records was conducted for patients treated with tocili- zumab for a cytokine storm related to COVID-19 between April 1, 2020, and April 1, 2021. Patient demographics, clinical characteristics, and laboratory parameters within 24 hours before tocilizumab were recorded. 1.14 × (age - 20) (years) + 1.63 × NLR + 5.00 × D-dimer (mg/L) + 0.14 × C-reactive protein (CRP) (mg/L) was used as the formula for the ANDC score. The study population was divided into 2 groups: those who died within 28 days of receiving tocilizumab and those who recovered. A comparative analysis was conducted.</p><p><strong>Results: </strong>Within 28 days of tocilizumab treatment, 59 (35.32%) patients died. In comparison with living patients, deceased patients exhibited considerably higher levels of interleukin (IL)-6, lactate dehydro- genase (LDH), ANDC score, and CRP (P < .05). Lactate dehydrogenase was an independent predictor of response to tocilizumab treatment (P < .001) in a multivariate logistic regression analysis. In patients who did not receive steroid therapy before tocilizumab treatment, the ANDC score had the highest area under the curve (AUC). The optimal cut-off value was determined to be 92.56, with a sensitivity of 91.67% and a specificity of 60.61% (P < .001). In patients receiving steroids before tocilizumab, LDH had the highest AUC. The optimal cut-off value was 484.5 U/L (P < .001).</p><p><strong>Conclusion: </strong>Lactate dehydrogenase was identified as an independent predictor of response to tocili- zumab treatment. The ANDC score showed the highest AUC value in steroid-naïve patients before tocilizumab, whereas LDH showed the highest AUC value in patients receiving steroids before tocili- zumab. Both the ANDC score and LDH levels show potential as valuable tools to guide treatment decisions.</p>\",\"PeriodicalId\":12066,\"journal\":{\"name\":\"European journal of rheumatology\",\"volume\":\"12 1\",\"pages\":\"1-6\"},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2025-04-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060182/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European journal of rheumatology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.5152/eurjrheum.2025.24048\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"RHEUMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European journal of rheumatology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5152/eurjrheum.2025.24048","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
Can the Early Warning Score (ANDC) Predict Tocilizumab Efficacy in Patients with COVID-19 Cytokine Storm?
Background: The aim of this study is to assess the effectiveness of the Early Warning Score [ANDC (age (A), neutrophil-to-lymphocyte ratio (NLR (N)), D-dimer (D), and CRP (C)] in predicting the treatment response in patients receiving tocilizumab for Coronavirus Disease 2019 (COVID-19)-related cytokine storm.
Methods: A retrospective review of medical records was conducted for patients treated with tocili- zumab for a cytokine storm related to COVID-19 between April 1, 2020, and April 1, 2021. Patient demographics, clinical characteristics, and laboratory parameters within 24 hours before tocilizumab were recorded. 1.14 × (age - 20) (years) + 1.63 × NLR + 5.00 × D-dimer (mg/L) + 0.14 × C-reactive protein (CRP) (mg/L) was used as the formula for the ANDC score. The study population was divided into 2 groups: those who died within 28 days of receiving tocilizumab and those who recovered. A comparative analysis was conducted.
Results: Within 28 days of tocilizumab treatment, 59 (35.32%) patients died. In comparison with living patients, deceased patients exhibited considerably higher levels of interleukin (IL)-6, lactate dehydro- genase (LDH), ANDC score, and CRP (P < .05). Lactate dehydrogenase was an independent predictor of response to tocilizumab treatment (P < .001) in a multivariate logistic regression analysis. In patients who did not receive steroid therapy before tocilizumab treatment, the ANDC score had the highest area under the curve (AUC). The optimal cut-off value was determined to be 92.56, with a sensitivity of 91.67% and a specificity of 60.61% (P < .001). In patients receiving steroids before tocilizumab, LDH had the highest AUC. The optimal cut-off value was 484.5 U/L (P < .001).
Conclusion: Lactate dehydrogenase was identified as an independent predictor of response to tocili- zumab treatment. The ANDC score showed the highest AUC value in steroid-naïve patients before tocilizumab, whereas LDH showed the highest AUC value in patients receiving steroids before tocili- zumab. Both the ANDC score and LDH levels show potential as valuable tools to guide treatment decisions.
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