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Predictors of Mortality in Tocilizumab-Treated Severe COVID-19
Purpose: Tocilizumab is associated with positive outcomes in severe COVID-19. We wanted to describe the characteristics of nonresponders to treatment. Methods: This was a retrospective multicenter study in two respiratory departments investigating adverse outcomes at 90 days from diagnosis in subjec...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9230711/ https://www.ncbi.nlm.nih.gov/pubmed/35746585 http://dx.doi.org/10.3390/vaccines10060978 |
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author | Pagkratis, Konstantinos Chrysikos, Serafeim Antonakis, Emmanouil Pandi, Aggeliki Kosti, Chrysavgi Nikolaou Markatis, Eleftherios Hillas, Georgios Digalaki, Antonia Koukidou, Sofia Chaini, Eleftheria Afthinos, Andreas Dimakou, Katerina Papanikolaou, Ilias C. |
author_facet | Pagkratis, Konstantinos Chrysikos, Serafeim Antonakis, Emmanouil Pandi, Aggeliki Kosti, Chrysavgi Nikolaou Markatis, Eleftherios Hillas, Georgios Digalaki, Antonia Koukidou, Sofia Chaini, Eleftheria Afthinos, Andreas Dimakou, Katerina Papanikolaou, Ilias C. |
author_sort | Pagkratis, Konstantinos |
collection | PubMed |
description | Purpose: Tocilizumab is associated with positive outcomes in severe COVID-19. We wanted to describe the characteristics of nonresponders to treatment. Methods: This was a retrospective multicenter study in two respiratory departments investigating adverse outcomes at 90 days from diagnosis in subjects treated with tocilizumab (8 mg/kg intravenously single dose) for severe progressive COVID-19. Results: Of 121 subjects, 62% were males, and 9% were fully vaccinated. Ninety-six (79.4%) survived, and 25 died (20.6%). Compared to survivors (S), nonsurvivors (NS) were older (median 57 versus 75 years of age), had more comorbidities (Charlson comorbidity index 2 versus 5) and had higher rates of intubation/mechanical ventilation (p < 0.05). On admission, NS had a lower PO(2)/FiO(2) ratio, higher blood ferritin, and higher troponin, and on clinical progression (day of tocilizumab treatment), NS had a lower PO(2)/FiO(2) ratio, decreased lymphocytes, increased neutrophil to lymphocyte ratio, increased ferritin and lactate dehydrogenase (LDH), disease located centrally on computed tomography scan, and increased late c-reactive protein. Cox proportional hazards regression analysis identified age and LDH on deterioration as predictors of death; admission PO(2)/FiO(2) ratio and LDH as predictors of intubation; PO(2)/FiO(2) ratios, LDH, and central lung disease on radiology as predictors of noninvasive ventilation (NIV) (a < 0.05). The log-rank test of mortality yielded the same results (p < 0.001). ROC analysis of the above predictors in a separate validation cohort yielded significant results. Conclusions: Older age and high serum LDH levels are predictors of mortality in tocilizumab-treated severe COVID-19 patients. Hypoxia levels, LDH, and central pulmonary involvement radiologically are associated with intubation and NIV. |
format | Online Article Text |
id | pubmed-9230711 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-92307112022-06-25 Predictors of Mortality in Tocilizumab-Treated Severe COVID-19 Pagkratis, Konstantinos Chrysikos, Serafeim Antonakis, Emmanouil Pandi, Aggeliki Kosti, Chrysavgi Nikolaou Markatis, Eleftherios Hillas, Georgios Digalaki, Antonia Koukidou, Sofia Chaini, Eleftheria Afthinos, Andreas Dimakou, Katerina Papanikolaou, Ilias C. Vaccines (Basel) Article Purpose: Tocilizumab is associated with positive outcomes in severe COVID-19. We wanted to describe the characteristics of nonresponders to treatment. Methods: This was a retrospective multicenter study in two respiratory departments investigating adverse outcomes at 90 days from diagnosis in subjects treated with tocilizumab (8 mg/kg intravenously single dose) for severe progressive COVID-19. Results: Of 121 subjects, 62% were males, and 9% were fully vaccinated. Ninety-six (79.4%) survived, and 25 died (20.6%). Compared to survivors (S), nonsurvivors (NS) were older (median 57 versus 75 years of age), had more comorbidities (Charlson comorbidity index 2 versus 5) and had higher rates of intubation/mechanical ventilation (p < 0.05). On admission, NS had a lower PO(2)/FiO(2) ratio, higher blood ferritin, and higher troponin, and on clinical progression (day of tocilizumab treatment), NS had a lower PO(2)/FiO(2) ratio, decreased lymphocytes, increased neutrophil to lymphocyte ratio, increased ferritin and lactate dehydrogenase (LDH), disease located centrally on computed tomography scan, and increased late c-reactive protein. Cox proportional hazards regression analysis identified age and LDH on deterioration as predictors of death; admission PO(2)/FiO(2) ratio and LDH as predictors of intubation; PO(2)/FiO(2) ratios, LDH, and central lung disease on radiology as predictors of noninvasive ventilation (NIV) (a < 0.05). The log-rank test of mortality yielded the same results (p < 0.001). ROC analysis of the above predictors in a separate validation cohort yielded significant results. Conclusions: Older age and high serum LDH levels are predictors of mortality in tocilizumab-treated severe COVID-19 patients. Hypoxia levels, LDH, and central pulmonary involvement radiologically are associated with intubation and NIV. MDPI 2022-06-20 /pmc/articles/PMC9230711/ /pubmed/35746585 http://dx.doi.org/10.3390/vaccines10060978 Text en © 2022 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 Pagkratis, Konstantinos Chrysikos, Serafeim Antonakis, Emmanouil Pandi, Aggeliki Kosti, Chrysavgi Nikolaou Markatis, Eleftherios Hillas, Georgios Digalaki, Antonia Koukidou, Sofia Chaini, Eleftheria Afthinos, Andreas Dimakou, Katerina Papanikolaou, Ilias C. Predictors of Mortality in Tocilizumab-Treated Severe COVID-19 |
title | Predictors of Mortality in Tocilizumab-Treated Severe COVID-19 |
title_full | Predictors of Mortality in Tocilizumab-Treated Severe COVID-19 |
title_fullStr | Predictors of Mortality in Tocilizumab-Treated Severe COVID-19 |
title_full_unstemmed | Predictors of Mortality in Tocilizumab-Treated Severe COVID-19 |
title_short | Predictors of Mortality in Tocilizumab-Treated Severe COVID-19 |
title_sort | predictors of mortality in tocilizumab-treated severe covid-19 |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9230711/ https://www.ncbi.nlm.nih.gov/pubmed/35746585 http://dx.doi.org/10.3390/vaccines10060978 |
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