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Effect of Tocilizumab on “Ventilator Free Days” Composite Outcome in SARS-CoV-2 Patients: A Retrospective Competing Risk Analysis

BACKGROUND: SARS-CoV-2 infection demonstrates a wide range of severity. More severe cases demonstrate a cytokine storm with elevated serum interleukin-6, hence IL-6 receptor antibody tocilizumab was tried for the management of severe cases. AIMS: Effect of tocilizumab on ventilator-free days among c...

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Autores principales: Mady, Ahmed F., Abdulrahman, Basheer, Mumtaz, Shahzad A., Al-Odat, Mohammed A., Kuhail, Ahmed, Altoraifi, Rehab, Alshae, Rayan, Alharthy, Abdulrahman M., Karakitsos, Dimitrios, Aletreby, Waleed Th.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Sciendo 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9949015/
https://www.ncbi.nlm.nih.gov/pubmed/36844963
http://dx.doi.org/10.2478/rjaic-2022-0001
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author Mady, Ahmed F.
Abdulrahman, Basheer
Mumtaz, Shahzad A.
Al-Odat, Mohammed A.
Kuhail, Ahmed
Altoraifi, Rehab
Alshae, Rayan
Alharthy, Abdulrahman M.
Karakitsos, Dimitrios
Aletreby, Waleed Th.
author_facet Mady, Ahmed F.
Abdulrahman, Basheer
Mumtaz, Shahzad A.
Al-Odat, Mohammed A.
Kuhail, Ahmed
Altoraifi, Rehab
Alshae, Rayan
Alharthy, Abdulrahman M.
Karakitsos, Dimitrios
Aletreby, Waleed Th.
author_sort Mady, Ahmed F.
collection PubMed
description BACKGROUND: SARS-CoV-2 infection demonstrates a wide range of severity. More severe cases demonstrate a cytokine storm with elevated serum interleukin-6, hence IL-6 receptor antibody tocilizumab was tried for the management of severe cases. AIMS: Effect of tocilizumab on ventilator-free days among critically ill SARS-CoV-2 patients. METHOD: Retrospective propensity score matching study, comparing mechanically ventilated patients who received tocilizumab to a control group. RESULTS: 29 patients in the intervention group were compared to 29 controls. Matched groups were similar. Ventilator-free days were more numerous in the intervention group (SHR 2.7, 95% CI: 1.2 – 6.3; p = 0.02), ICU mortality rate was not different (37.9% versus 62%, p = 0.1), actual ventilator-free periods were significantly longer in tocilizumab group (mean difference 4.7 days; p = 0.02). Sensitivity analysis showed a significantly lower hazard ratio of death in tocilizumab group (HR 0.49, 95% CI: 0.25 – 0.97; p = 0.04). There was no difference in positive cultures among groups (55.2% in tocilizumab group versus 34.5% in the control; p = 0.1). CONCLUSION: Tocilizumab may improve the composite outcome of ventilator-free days at day 28 among mechanically ventilated SARS-CoV-2 patients; it is associated with significantly longer actual ventilator-free periods, and insignificantly lower mortality and higher superinfection.
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spelling pubmed-99490152023-02-24 Effect of Tocilizumab on “Ventilator Free Days” Composite Outcome in SARS-CoV-2 Patients: A Retrospective Competing Risk Analysis Mady, Ahmed F. Abdulrahman, Basheer Mumtaz, Shahzad A. Al-Odat, Mohammed A. Kuhail, Ahmed Altoraifi, Rehab Alshae, Rayan Alharthy, Abdulrahman M. Karakitsos, Dimitrios Aletreby, Waleed Th. Rom J Anaesth Intensive Care Original Paper BACKGROUND: SARS-CoV-2 infection demonstrates a wide range of severity. More severe cases demonstrate a cytokine storm with elevated serum interleukin-6, hence IL-6 receptor antibody tocilizumab was tried for the management of severe cases. AIMS: Effect of tocilizumab on ventilator-free days among critically ill SARS-CoV-2 patients. METHOD: Retrospective propensity score matching study, comparing mechanically ventilated patients who received tocilizumab to a control group. RESULTS: 29 patients in the intervention group were compared to 29 controls. Matched groups were similar. Ventilator-free days were more numerous in the intervention group (SHR 2.7, 95% CI: 1.2 – 6.3; p = 0.02), ICU mortality rate was not different (37.9% versus 62%, p = 0.1), actual ventilator-free periods were significantly longer in tocilizumab group (mean difference 4.7 days; p = 0.02). Sensitivity analysis showed a significantly lower hazard ratio of death in tocilizumab group (HR 0.49, 95% CI: 0.25 – 0.97; p = 0.04). There was no difference in positive cultures among groups (55.2% in tocilizumab group versus 34.5% in the control; p = 0.1). CONCLUSION: Tocilizumab may improve the composite outcome of ventilator-free days at day 28 among mechanically ventilated SARS-CoV-2 patients; it is associated with significantly longer actual ventilator-free periods, and insignificantly lower mortality and higher superinfection. Sciendo 2023-01-14 /pmc/articles/PMC9949015/ /pubmed/36844963 http://dx.doi.org/10.2478/rjaic-2022-0001 Text en © 2022 Ahmed F. Mady et al., published by Sciendo https://creativecommons.org/licenses/by-nc-nd/3.0/This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
spellingShingle Original Paper
Mady, Ahmed F.
Abdulrahman, Basheer
Mumtaz, Shahzad A.
Al-Odat, Mohammed A.
Kuhail, Ahmed
Altoraifi, Rehab
Alshae, Rayan
Alharthy, Abdulrahman M.
Karakitsos, Dimitrios
Aletreby, Waleed Th.
Effect of Tocilizumab on “Ventilator Free Days” Composite Outcome in SARS-CoV-2 Patients: A Retrospective Competing Risk Analysis
title Effect of Tocilizumab on “Ventilator Free Days” Composite Outcome in SARS-CoV-2 Patients: A Retrospective Competing Risk Analysis
title_full Effect of Tocilizumab on “Ventilator Free Days” Composite Outcome in SARS-CoV-2 Patients: A Retrospective Competing Risk Analysis
title_fullStr Effect of Tocilizumab on “Ventilator Free Days” Composite Outcome in SARS-CoV-2 Patients: A Retrospective Competing Risk Analysis
title_full_unstemmed Effect of Tocilizumab on “Ventilator Free Days” Composite Outcome in SARS-CoV-2 Patients: A Retrospective Competing Risk Analysis
title_short Effect of Tocilizumab on “Ventilator Free Days” Composite Outcome in SARS-CoV-2 Patients: A Retrospective Competing Risk Analysis
title_sort effect of tocilizumab on “ventilator free days” composite outcome in sars-cov-2 patients: a retrospective competing risk analysis
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9949015/
https://www.ncbi.nlm.nih.gov/pubmed/36844963
http://dx.doi.org/10.2478/rjaic-2022-0001
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