Yoğun Bakım Ünitesine Kabul Edilen COVID-19 Hastalarında Tocilizumab Kullanımının Mortalite Üzerine Etkisi

Abstract

Amaç: Koronavirüs hastalığı 2019 (coronavirus disease 2019, COVID-19) çoğunlukla hafif solunum semptomları ile seyreder, ancak bazen şiddetli pnömoni, sitokin fırtınası ve akut solunum sıkıntısı sendromu gelişebilir. Sitokin fırtınası için anti-sitokin tedaviler denenmektedir. Bu çalışmada, tocilizumabın COVID-19 ile ilişkili mortalite üzerindeki etkisinin incelenmesi amaçlandı. Gereç ve Yöntemler: Çalışmaya, COVID-19’a bağlı orta-şiddetli akut solunum sıkıntısı sendromu olan 146 hasta dahil edildi. Hastalar sadece standart tedavi alanlar (ST grubu, n=44) ve standart tedavi ile birlikte tocilizumab tedavisi alanlar (TCZ grubu, n=102) olmak üzere iki gruba ayrıldı. Gruplar demografik, klinik ve laboratuvar verileri açısından karşılaştırıldı. Tocilizumabın mortalite üzerindeki etkisini tespit etmek için mortalite oranları da belirlendi. Bulgular: Genel olarak, hastaların %36,3'ü (n=53) kadın, %63,7'si (n=93) erkek ve yaş ortalaması 69,5±14,2 yıl idi. Mortalite oranı TCZ grubunda %29,4 (n=30) ve ST grubunda ise %52,3 (n=23) idi (p=0,009). Hastaların yoğun bakım ünitesine (YBÜ) kabuldeki C-reaktif protein, fibrinojen ve laktat seviyeleri gruplar arasında benzer iken, TCZ grubunda ferritin seviyeleri daha yüksekti (p=0,006). YBÜ’den taburcu olduklarında TCZ grubunda C-reaktif protein'de anlamlı bir düşüş olurken (p<0,001), ferritin seviyeleri ST grubundaki seviyelere geriledi (p=0,134). Tedavi rejiminde tocilizumabın olmaması, mortalite riskinde 2,63 katlık bir artış ile ilişkili bulundu. Sonuç: Tocilizumab YBÜ’de takip edilen COVID-19 hastalarında mortaliteyi azaltmaktadır. Bununla birlikte, tocilizumabın etkinliğini ve yan etkilerini daha iyi aydınlatmak için daha fazla çalışmaya ihtiyaç vardır.

Keywords

• COVID-19;
• sitokin fırtınası;
• tosilizumab;
• mortalite;
• interlökin 6.

Effect of Tocilizumab Use on Mortality in COVID-19 Patients Admitted to Intensive Care Unit

Abstract

Aim: Coronavirus disease 2019 (COVID-19) mostly proceeds with mild respiratory symptoms, but sometimes severe pneumonia, cytokine storm, and acute respiratory distress syndrome can develop. Anti-cytokine treatments are being tried for cytokine storm. In this study, we aimed to examine the effect of tocilizumab on mortality associated with COVID-19. Material and Methods: The study included 146 patients with moderate-to-severe acute respiratory distress syndrome diagnosed with COVID-19. The patients were divided into two groups, receiving only standard treatment (ST group, n=44), and tocilizumab treatment in addition to standard treatment (TCZ group, n=102). Groups were compared in terms of demographic, clinic, and laboratory data. Also, mortality rates were determined to detect the effect of tocilizumab on mortality. Results: Overall, 36.3% (n=53) of the patients were female, 63.7% (n=93) were male, and the mean age was 69.5±14.2 years. The mortality rate was 29.4% (n=30) in the TCZ group and 52.3% (n=23) in the ST group (p=0.009). While C-reactive protein, fibrinogen, and lactate levels on admission to the intensive care unit (ICU) were similar across the groups, the TCZ group had higher ferritin levels (p=0.006). On discharge from ICU, the TCZ group had a significant decrease in C-reactive protein (p<0.001), while their ferritin levels decreased to levels in the ST group (p=0.134). The absence of tocilizumab in the treatment regimen was associated with a 2.63-fold increase in the mortality risk. Conclusion: Tocilizumab reduces the mortality in COVID-19 patients in ICU. However, further studies are warranted to better elucidate the efficacy and side effects of tocilizumab.

Keywords

• COVID-19;
• cytokine storm;
• tocilizumab;
• mortality;
• interleukin 6.

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