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Date of Admission during COVID-19 Pandemic Impacted Patient Outcomes in Addition to the Higher Efficacy of Tocilizumab Plus High-Dose Corticosteroid Therapy Compared to Tocilizumab Alone

Background: The evidence for the efficacy of glucocorticoids combined with tocilizumab (TCZ) in COVID-19 comes from observational studies or subgroup analysis. Our aim was to compare outcomes between hospitalized COVID-19 patients who received high-dose corticosteroid pulse therapy and TCZ and those...

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Autores principales: Belhassen-García, Moncef, Sánchez-Puente, Antonio, Dorado-Díaz, Pedro-Ignacio, López-Bernús, Amparo, Sampedro-Gómez, Jesús, Azibeiro-Melchor, Raúl, Marcano-Millán, Edgard, Rodríguez-Alonso, Beatriz, Sánchez-Barrado, María-Elisa, Hernández-García, Ignacio, Madruga, Ignacio, Hernández-Pérez, Guillermo, Carbonell, Cristina, García-Aparicio, Judit, Burgos, Laura, López-Sánchez, Eugenia, Reina, Carlos, Ramón, Ana-María, Cestero-Ramírez, Laura, Boumhir, Fátima, Encinas-Sánchez, Daniel, Sánchez-Ledesma, María, Herráez, Jacinto, Araoz, Patricia, Sánchez-Crespo, María-José, Rodríguez-Rodríguez, Sandra, Rodríguez-Gude, Ana-Elisa, Sánchez-Hernández, Miguel-Vicente, Borrás, Rafael, Sagredo-Meneses, Víctor, Sánchez, Pedro-Luis, Marcos, Miguel, Martín-Oterino, José-Ángel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8746130/
https://www.ncbi.nlm.nih.gov/pubmed/35011938
http://dx.doi.org/10.3390/jcm11010198
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author Belhassen-García, Moncef
Sánchez-Puente, Antonio
Dorado-Díaz, Pedro-Ignacio
López-Bernús, Amparo
Sampedro-Gómez, Jesús
Azibeiro-Melchor, Raúl
Marcano-Millán, Edgard
Rodríguez-Alonso, Beatriz
Sánchez-Barrado, María-Elisa
Hernández-García, Ignacio
Madruga, Ignacio
Hernández-Pérez, Guillermo
Carbonell, Cristina
García-Aparicio, Judit
Burgos, Laura
López-Sánchez, Eugenia
Reina, Carlos
Ramón, Ana-María
Cestero-Ramírez, Laura
Boumhir, Fátima
Encinas-Sánchez, Daniel
Sánchez-Ledesma, María
Herráez, Jacinto
Araoz, Patricia
Sánchez-Crespo, María-José
Rodríguez-Rodríguez, Sandra
Rodríguez-Gude, Ana-Elisa
Sánchez-Hernández, Miguel-Vicente
Borrás, Rafael
Sagredo-Meneses, Víctor
Sánchez, Pedro-Luis
Marcos, Miguel
Martín-Oterino, José-Ángel
author_facet Belhassen-García, Moncef
Sánchez-Puente, Antonio
Dorado-Díaz, Pedro-Ignacio
López-Bernús, Amparo
Sampedro-Gómez, Jesús
Azibeiro-Melchor, Raúl
Marcano-Millán, Edgard
Rodríguez-Alonso, Beatriz
Sánchez-Barrado, María-Elisa
Hernández-García, Ignacio
Madruga, Ignacio
Hernández-Pérez, Guillermo
Carbonell, Cristina
García-Aparicio, Judit
Burgos, Laura
López-Sánchez, Eugenia
Reina, Carlos
Ramón, Ana-María
Cestero-Ramírez, Laura
Boumhir, Fátima
Encinas-Sánchez, Daniel
Sánchez-Ledesma, María
Herráez, Jacinto
Araoz, Patricia
Sánchez-Crespo, María-José
Rodríguez-Rodríguez, Sandra
Rodríguez-Gude, Ana-Elisa
Sánchez-Hernández, Miguel-Vicente
Borrás, Rafael
Sagredo-Meneses, Víctor
Sánchez, Pedro-Luis
Marcos, Miguel
Martín-Oterino, José-Ángel
author_sort Belhassen-García, Moncef
collection PubMed
description Background: The evidence for the efficacy of glucocorticoids combined with tocilizumab (TCZ) in COVID-19 comes from observational studies or subgroup analysis. Our aim was to compare outcomes between hospitalized COVID-19 patients who received high-dose corticosteroid pulse therapy and TCZ and those who received TCZ. Methods: A retrospective single-center study was performed on consecutive hospitalized patients with severe COVID-19 between 1 March and 23 April 2020. Patients treated with either TCZ (400–600 mg, one to two doses) and methylprednisolone pulses (MPD-TCZ group) or TCZ alone were analyzed for the occurrence of a combined endpoint of death and need for invasive mechanical ventilation during admission. The independence of both treatment groups was tested using machine learning classifiers, and relevant variables that were potentially different between the groups were measured through a mean decrease accuracy algorithm. Results: An earlier date of admission was significantly associated with worse outcomes regardless of treatment type. Twenty patients died (27.0%) in the TCZ group, and 33 (44.6%) died or required intubation (n = 74), whereas in the MPD-TCZ group, 15 (11.0%) patients died and 29 (21.3%) patients reached the combined endpoint (n = 136; p = 0.006 and p < 0.001, respectively). Machine learning methodology using a random forest classifier confirmed significant differences between the treatment groups. Conclusions: MPD and TCZ improved outcomes (death and invasive mechanical ventilation) among hospitalized COVID-19 patients, but confounding variables such as the date of admission during the COVID-19 pandemic should be considered in observational studies.
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spelling pubmed-87461302022-01-11 Date of Admission during COVID-19 Pandemic Impacted Patient Outcomes in Addition to the Higher Efficacy of Tocilizumab Plus High-Dose Corticosteroid Therapy Compared to Tocilizumab Alone Belhassen-García, Moncef Sánchez-Puente, Antonio Dorado-Díaz, Pedro-Ignacio López-Bernús, Amparo Sampedro-Gómez, Jesús Azibeiro-Melchor, Raúl Marcano-Millán, Edgard Rodríguez-Alonso, Beatriz Sánchez-Barrado, María-Elisa Hernández-García, Ignacio Madruga, Ignacio Hernández-Pérez, Guillermo Carbonell, Cristina García-Aparicio, Judit Burgos, Laura López-Sánchez, Eugenia Reina, Carlos Ramón, Ana-María Cestero-Ramírez, Laura Boumhir, Fátima Encinas-Sánchez, Daniel Sánchez-Ledesma, María Herráez, Jacinto Araoz, Patricia Sánchez-Crespo, María-José Rodríguez-Rodríguez, Sandra Rodríguez-Gude, Ana-Elisa Sánchez-Hernández, Miguel-Vicente Borrás, Rafael Sagredo-Meneses, Víctor Sánchez, Pedro-Luis Marcos, Miguel Martín-Oterino, José-Ángel J Clin Med Article Background: The evidence for the efficacy of glucocorticoids combined with tocilizumab (TCZ) in COVID-19 comes from observational studies or subgroup analysis. Our aim was to compare outcomes between hospitalized COVID-19 patients who received high-dose corticosteroid pulse therapy and TCZ and those who received TCZ. Methods: A retrospective single-center study was performed on consecutive hospitalized patients with severe COVID-19 between 1 March and 23 April 2020. Patients treated with either TCZ (400–600 mg, one to two doses) and methylprednisolone pulses (MPD-TCZ group) or TCZ alone were analyzed for the occurrence of a combined endpoint of death and need for invasive mechanical ventilation during admission. The independence of both treatment groups was tested using machine learning classifiers, and relevant variables that were potentially different between the groups were measured through a mean decrease accuracy algorithm. Results: An earlier date of admission was significantly associated with worse outcomes regardless of treatment type. Twenty patients died (27.0%) in the TCZ group, and 33 (44.6%) died or required intubation (n = 74), whereas in the MPD-TCZ group, 15 (11.0%) patients died and 29 (21.3%) patients reached the combined endpoint (n = 136; p = 0.006 and p < 0.001, respectively). Machine learning methodology using a random forest classifier confirmed significant differences between the treatment groups. Conclusions: MPD and TCZ improved outcomes (death and invasive mechanical ventilation) among hospitalized COVID-19 patients, but confounding variables such as the date of admission during the COVID-19 pandemic should be considered in observational studies. MDPI 2021-12-30 /pmc/articles/PMC8746130/ /pubmed/35011938 http://dx.doi.org/10.3390/jcm11010198 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Belhassen-García, Moncef
Sánchez-Puente, Antonio
Dorado-Díaz, Pedro-Ignacio
López-Bernús, Amparo
Sampedro-Gómez, Jesús
Azibeiro-Melchor, Raúl
Marcano-Millán, Edgard
Rodríguez-Alonso, Beatriz
Sánchez-Barrado, María-Elisa
Hernández-García, Ignacio
Madruga, Ignacio
Hernández-Pérez, Guillermo
Carbonell, Cristina
García-Aparicio, Judit
Burgos, Laura
López-Sánchez, Eugenia
Reina, Carlos
Ramón, Ana-María
Cestero-Ramírez, Laura
Boumhir, Fátima
Encinas-Sánchez, Daniel
Sánchez-Ledesma, María
Herráez, Jacinto
Araoz, Patricia
Sánchez-Crespo, María-José
Rodríguez-Rodríguez, Sandra
Rodríguez-Gude, Ana-Elisa
Sánchez-Hernández, Miguel-Vicente
Borrás, Rafael
Sagredo-Meneses, Víctor
Sánchez, Pedro-Luis
Marcos, Miguel
Martín-Oterino, José-Ángel
Date of Admission during COVID-19 Pandemic Impacted Patient Outcomes in Addition to the Higher Efficacy of Tocilizumab Plus High-Dose Corticosteroid Therapy Compared to Tocilizumab Alone
title Date of Admission during COVID-19 Pandemic Impacted Patient Outcomes in Addition to the Higher Efficacy of Tocilizumab Plus High-Dose Corticosteroid Therapy Compared to Tocilizumab Alone
title_full Date of Admission during COVID-19 Pandemic Impacted Patient Outcomes in Addition to the Higher Efficacy of Tocilizumab Plus High-Dose Corticosteroid Therapy Compared to Tocilizumab Alone
title_fullStr Date of Admission during COVID-19 Pandemic Impacted Patient Outcomes in Addition to the Higher Efficacy of Tocilizumab Plus High-Dose Corticosteroid Therapy Compared to Tocilizumab Alone
title_full_unstemmed Date of Admission during COVID-19 Pandemic Impacted Patient Outcomes in Addition to the Higher Efficacy of Tocilizumab Plus High-Dose Corticosteroid Therapy Compared to Tocilizumab Alone
title_short Date of Admission during COVID-19 Pandemic Impacted Patient Outcomes in Addition to the Higher Efficacy of Tocilizumab Plus High-Dose Corticosteroid Therapy Compared to Tocilizumab Alone
title_sort date of admission during covid-19 pandemic impacted patient outcomes in addition to the higher efficacy of tocilizumab plus high-dose corticosteroid therapy compared to tocilizumab alone
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8746130/
https://www.ncbi.nlm.nih.gov/pubmed/35011938
http://dx.doi.org/10.3390/jcm11010198
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