Tocilizumab improves survival in severe COVID-19 pneumonia with persistent hypoxia: a retrospective cohort study with follow-up from Mumbai, India
Abstract Background Cytokine storm triggered by Severe Coronavirus Disease 2019 (COVID-19) is associated with high mortality. With high Interleukin -6 (IL-6) levels reported in COVID-19 related deaths in China, IL-6 is considered to be the key player in COVID-19 cytokine storm. Tocilizumab, a monocl...
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| Format: | Article |
| Language: | English |
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BMC
2021-03-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-021-05912-3 |
| _version_ | 1818676452000792576 |
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| author | Yojana Gokhale Rakshita Mehta Uday Kulkarni Nitin Karnik Sushant Gokhale Uma Sundar Swati Chavan Akshay Kor Sonal Thakur Trupti Trivedi Naveen Kumar Sujata Baveja Aniket Wadal Shaonak Kolte Aukshan Deolankar Sangeeta Pednekar Lalana Kalekar Rupal Padiyar Charulata Londhe Pramod Darole Sujata Pol Seema Bansode Gokhe Namita Padwal Dharmendra Pandey Dhirendra Yadav Anagha Joshi Harshal Badgujar Mayuri Trivedi Priyanshu Shah Prerna Bhavsar |
| author_facet | Yojana Gokhale Rakshita Mehta Uday Kulkarni Nitin Karnik Sushant Gokhale Uma Sundar Swati Chavan Akshay Kor Sonal Thakur Trupti Trivedi Naveen Kumar Sujata Baveja Aniket Wadal Shaonak Kolte Aukshan Deolankar Sangeeta Pednekar Lalana Kalekar Rupal Padiyar Charulata Londhe Pramod Darole Sujata Pol Seema Bansode Gokhe Namita Padwal Dharmendra Pandey Dhirendra Yadav Anagha Joshi Harshal Badgujar Mayuri Trivedi Priyanshu Shah Prerna Bhavsar |
| author_sort | Yojana Gokhale |
| collection | DOAJ |
| description | Abstract Background Cytokine storm triggered by Severe Coronavirus Disease 2019 (COVID-19) is associated with high mortality. With high Interleukin -6 (IL-6) levels reported in COVID-19 related deaths in China, IL-6 is considered to be the key player in COVID-19 cytokine storm. Tocilizumab, a monoclonal antibody against IL-6 receptor, is used on compassionate grounds for treatment of COVID-19 cytokine storm. The aim of this study was to assess effect of tocilizumab on mortality due to COVID-19 cytokine storm. Method This retrospective, observational study included patients of severe COVID-19 pneumonia with persistent hypoxia (defined as saturation 94% or less on supplemental Oxygen of 15 L per minute through non-rebreathing mask or PaO2/FiO2 ratio of less than 200) who were admitted to a tertiary care center in Mumbai, India, between 31st March to 5th July 2020. In addition to standard care, single Inj. Tocilizumab 400 mg was given intravenously to 151 consecutive COVID-19 patients with persistent hypoxia, from 13th May to 5th July 2020. These 151 patients were retrospectively analysed and compared with historic controls, ie consecutive COVID-19 patients with persistent hypoxia, defined as stated above (N = 118, from our first COVID-19 admission on 31st March to 12th May 2020 i.e., till tocilizumab was available in hospital). Univariate and multivariate Cox regression analysis was performed for identifying predictors of survival. Statistical analysis was performed using IBM SPSS version 26. Results Out of 269 (151 in tocilizumab group and 118 historic controls) patients studied from 31st March to 5th July 2020, median survival in the tocilizumab group was significantly longer than in the control group; 18 days (95% CI, 11.3 to 24.7) versus 9 days (95% CI, 5.7 to 12.3); log rank p 0.007. On multivariate Cox regression analysis, independent predictors of survival were use of tocilizumab (HR 0.621, 95% CI 0.427–0.903, P 0.013) and higher oxygen saturation. Conclusion Tocilizumab may improve survival in severe COVID-19 pneumonia with persistent hypoxia. Randomised controlled trials on use of tocilizumab as rescue therapy in patients of severe COVID-19 pneumonia with hypoxia (PaO2/FiO2 less than 200) due to hyperinflammatory state, are warranted. |
| first_indexed | 2024-12-17T08:43:42Z |
| format | Article |
| id | doaj.art-f79d7ae8a3ce48bc85be1c0665339bc0 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-17T08:43:42Z |
| publishDate | 2021-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-f79d7ae8a3ce48bc85be1c0665339bc02022-12-21T21:56:15ZengBMCBMC Infectious Diseases1471-23342021-03-0121111010.1186/s12879-021-05912-3Tocilizumab improves survival in severe COVID-19 pneumonia with persistent hypoxia: a retrospective cohort study with follow-up from Mumbai, IndiaYojana Gokhale0Rakshita Mehta1Uday Kulkarni2Nitin Karnik3Sushant Gokhale4Uma Sundar5Swati Chavan6Akshay Kor7Sonal Thakur8Trupti Trivedi9Naveen Kumar10Sujata Baveja11Aniket Wadal12Shaonak Kolte13Aukshan Deolankar14Sangeeta Pednekar15Lalana Kalekar16Rupal Padiyar17Charulata Londhe18Pramod Darole19Sujata Pol20Seema Bansode Gokhe21Namita Padwal22Dharmendra Pandey23Dhirendra Yadav24Anagha Joshi25Harshal Badgujar26Mayuri Trivedi27Priyanshu Shah28Prerna Bhavsar29Lokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeChristian Medical CollegeLokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeLokmanya Tilak Municipal Medical CollegeAbstract Background Cytokine storm triggered by Severe Coronavirus Disease 2019 (COVID-19) is associated with high mortality. With high Interleukin -6 (IL-6) levels reported in COVID-19 related deaths in China, IL-6 is considered to be the key player in COVID-19 cytokine storm. Tocilizumab, a monoclonal antibody against IL-6 receptor, is used on compassionate grounds for treatment of COVID-19 cytokine storm. The aim of this study was to assess effect of tocilizumab on mortality due to COVID-19 cytokine storm. Method This retrospective, observational study included patients of severe COVID-19 pneumonia with persistent hypoxia (defined as saturation 94% or less on supplemental Oxygen of 15 L per minute through non-rebreathing mask or PaO2/FiO2 ratio of less than 200) who were admitted to a tertiary care center in Mumbai, India, between 31st March to 5th July 2020. In addition to standard care, single Inj. Tocilizumab 400 mg was given intravenously to 151 consecutive COVID-19 patients with persistent hypoxia, from 13th May to 5th July 2020. These 151 patients were retrospectively analysed and compared with historic controls, ie consecutive COVID-19 patients with persistent hypoxia, defined as stated above (N = 118, from our first COVID-19 admission on 31st March to 12th May 2020 i.e., till tocilizumab was available in hospital). Univariate and multivariate Cox regression analysis was performed for identifying predictors of survival. Statistical analysis was performed using IBM SPSS version 26. Results Out of 269 (151 in tocilizumab group and 118 historic controls) patients studied from 31st March to 5th July 2020, median survival in the tocilizumab group was significantly longer than in the control group; 18 days (95% CI, 11.3 to 24.7) versus 9 days (95% CI, 5.7 to 12.3); log rank p 0.007. On multivariate Cox regression analysis, independent predictors of survival were use of tocilizumab (HR 0.621, 95% CI 0.427–0.903, P 0.013) and higher oxygen saturation. Conclusion Tocilizumab may improve survival in severe COVID-19 pneumonia with persistent hypoxia. Randomised controlled trials on use of tocilizumab as rescue therapy in patients of severe COVID-19 pneumonia with hypoxia (PaO2/FiO2 less than 200) due to hyperinflammatory state, are warranted.https://doi.org/10.1186/s12879-021-05912-3IL-6Interlukin-6Cytokine stormHyperinflammatory syndromeCO-RADSCT-severity score |
| spellingShingle | Yojana Gokhale Rakshita Mehta Uday Kulkarni Nitin Karnik Sushant Gokhale Uma Sundar Swati Chavan Akshay Kor Sonal Thakur Trupti Trivedi Naveen Kumar Sujata Baveja Aniket Wadal Shaonak Kolte Aukshan Deolankar Sangeeta Pednekar Lalana Kalekar Rupal Padiyar Charulata Londhe Pramod Darole Sujata Pol Seema Bansode Gokhe Namita Padwal Dharmendra Pandey Dhirendra Yadav Anagha Joshi Harshal Badgujar Mayuri Trivedi Priyanshu Shah Prerna Bhavsar Tocilizumab improves survival in severe COVID-19 pneumonia with persistent hypoxia: a retrospective cohort study with follow-up from Mumbai, India BMC Infectious Diseases IL-6 Interlukin-6 Cytokine storm Hyperinflammatory syndrome CO-RADS CT-severity score |
| title | Tocilizumab improves survival in severe COVID-19 pneumonia with persistent hypoxia: a retrospective cohort study with follow-up from Mumbai, India |
| title_full | Tocilizumab improves survival in severe COVID-19 pneumonia with persistent hypoxia: a retrospective cohort study with follow-up from Mumbai, India |
| title_fullStr | Tocilizumab improves survival in severe COVID-19 pneumonia with persistent hypoxia: a retrospective cohort study with follow-up from Mumbai, India |
| title_full_unstemmed | Tocilizumab improves survival in severe COVID-19 pneumonia with persistent hypoxia: a retrospective cohort study with follow-up from Mumbai, India |
| title_short | Tocilizumab improves survival in severe COVID-19 pneumonia with persistent hypoxia: a retrospective cohort study with follow-up from Mumbai, India |
| title_sort | tocilizumab improves survival in severe covid 19 pneumonia with persistent hypoxia a retrospective cohort study with follow up from mumbai india |
| topic | IL-6 Interlukin-6 Cytokine storm Hyperinflammatory syndrome CO-RADS CT-severity score |
| url | https://doi.org/10.1186/s12879-021-05912-3 |
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