Factors Affecting Mortality in COVID-19 Pneumonia Patients Treated with Tocilizumab

Selda Günaydın; Hayriye Bektaş Aksoy; İskender Aksoy; Abdülbaki Elmas; Ahmet Cumhur Dülger

doi:10.18621/eurj.1829791

Factors Affecting Mortality in COVID-19 Pneumonia Patients Treated with Tocilizumab

Abstract

Objectives: Severe COVID-19 pneumonia is often complicated by hyperinflammation and multiorgan failure. Tocilizumab, an interleukin-6 receptor antagonist, has been used to mitigate cytokine storm; however, it’s prognostic impact remains uncertain.

Methods: This retrospective cohort study included 43 adult patients with PCR-confirmed COVID-19 pneumonia who received tocilizumab at a tertiary hospital in Turkiye between April and September 2020. Patients were categorized as survivors or non-survivors. Demographic data and laboratory markers were analyzed at baseline, 24 hours, and 7 days post-treatment. Statistical analyses included Mann–Whitney U, Wilcoxon signed-rank, and chi-square tests.

Results: Non-survivors were significantly older (mean age: 72.4 vs. 64.9 years, P=0.046) and had higher levels of C-reactive protein (P=0.002), D-dimer (P=0.004), procalcitonin (P= 0.001), troponin (P=0.004), BUN (P<0.001) and creatinine (P=0.02). Survivors showed higher albumin and prognostic nutritional index (PNI) values (P=0.009 and P<0.001, respectively). On day 7, survivors exhibited increased lymphocyte, eosinophil, and platelet counts, while non-survivors had persistent neutrophilia, leukocytosis, and elevated neutrophil-to-lymphocyte ratios (P<0.05). Dynamic biomarker trends suggested ongoing inflammation and prothrombotic states among non-survivors.

Conclusions: Tocilizumab therapy may be more effective when administered early and in patients with preserved nutritional and immune function. Advanced age, renal dysfunction, elevated inflammatory markers, and poor nutritional status were significant predictors of mortality. Further prospective studies are warranted to validate these findings.

Keywords

Ethical Statement

This study was approved by the Ordu University Clinical Research Ethics Committee. (Decision No: 2020/22-226; date: 27.10.2020). All procedures were conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. Given the retrospective nature of the study, patient consent was not required, but data were anonymized to protect patient confidentiality.

References

1. Xu X, Han M, Li T, ET AL. Effective treatment of severe COVID-19 patients with tocilizumab. Proc Natl Acad Sci U S A. 2020;117(20):10970-10975. doi: 10.1073/pnas.2005615117.
2. Zhonghua Liu Xing Bing Xue Za Zhi. Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. [The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China]. 2020 Feb 10;41(2):145-151. doi: 10.3760/cma.j.issn.0254-6450.2020.02.003. [Article in Chinese]
3. Zhang C, Wu Z, Li JW, Zhao H, Wang GQ. Cytokine release syndrome in severe COVID-19: interleukin-6 receptor antagonist tocilizumab may be the key to reduce mortality. Int J Antimicrob Agents. 2020;55(5):105954. doi: 10.1016/j.ijantimicag.2020.105954.
4. Stone JH, Tuckwell K, Dimonaco S, et al. Trial of Tocilizumab in Giant-Cell Arteritis. N Engl J Med. 2017;377(4):317-328. doi: 10.1056/NEJMoa1613849.
5. Republic of Turkey Ministry of Health. Anticytokine-antiinflammatory treatments, coagulopathy management. Ankara: Ministry of Health Publications; 2021.
6. Luo P, Liu Y, Qiu L, Liu X, Liu D, Li J. Tocilizumab treatment in COVID-19: A single center experience. J Med Virol. 2020;92(7):814-818. doi: 10.1002/jmv.25801.
7. REMAP-CAP Investigators; Gordon AC, Mouncey PR, Al-Beidh F, et al. Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19. N Engl J Med. 2021;384(16):1491-1502. doi: 10.1056/NEJMoa2100433.
8. RECOVERY Collaborative Group. Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet. 2021;397(10285):1637-1645. doi: 10.1016/S0140-6736(21)00676-0.

9. Soetedjo NNM, Iryaningrum MR, Damara FA, et al. Prognostic properties of hypoalbuminemia in COVID-19 patients: A systematic review and diagnostic meta-analysis. Clin Nutr ESPEN. 2021;45:120-126. doi: 10.1016/j.clnesp.2021.07.003.
10. Anzo FM, Buan-Mayo M. Nutritional biomarkers as predictors of clinical outcomes between COVID-19 severity groups in a tertiary government hospital. Clin Nutr ESPEN. 2023;53:134-143. doi: 10.1016/j.clnesp.2022.12.005.
11. Pehlivanlar Küçük M, Küçük AO, Pehlivanlar A, et al. Effect of tocilizumab on intensive care patients with Covid-19 pneumonia, a retrospective cohort study. Turk J Med Sci. 2022;52(1):39-49. doi: 10.3906/sag-2106-42.
12. Kaya H, Öksüzler Kızılbay G, Ilgazlı AH, Özgür EG. Tocilizumab in hospitalized patients with severe COVID-19 pneumonia: A single-center observational study. Eurasian J Pulmonol 2024;26(1):41-50. Doi: 10.14744/ejp.2023.4009.
13. MacGregor F, Oprey A, Caulfield C, MacTavish P, Lowrie R, Henderson P. Does timing of tocilizumab administration affect mortality in COVID-19? A Scottish multicentre retrospective cohort study. BMJ Open Respir Res. 2024;11(1):e002264. doi: 10.1136/bmjresp-2023-002264.
14. Toniati P, Piva S, Cattalini M, et al. Tocilizumab for the treatment of severe COVID-19 pneumonia with hyperinflammatory syndrome and acute respiratory failure: A single center study of 100 patients in Brescia, Italy. Autoimmun Rev. 2020;19(7):102568. doi: 10.1016/j.autrev.2020.102568.
15. Tosun M, Ölmez H. Effect of Tocilizumab Use on Mortality in COVID-19 Patients Admitted to Intensive Care Unit. Duzce Med J. 2022;24(3):227–234. doi: 10.18678/dtfd.1108303.
16. Cibis C, Adam EH, Gatzke F, Rauchfuss S, Roth S, Miesbach W. Coagulation Biomarkers and Mortality in Severe COVID-19: The Prognostic Value of Factor XIII Decline and Elevated D-Dimers. Clin Appl Thromb Hemost. 2025;31:10760296251364266. doi: 10.1177/10760296251364266.

Details

Primary Language

English

Subjects

Chest Diseases

Journal Section

Research Article

Authors

Selda Günaydın ^*
0000-0001-5641-012X
Türkiye

Hayriye Bektaş Aksoy
0000-0002-4390-5198
Türkiye

İskender Aksoy
0000-0002-4426-3342
Türkiye

Abdülbaki Elmas
0000-0002-7524-251X
Türkiye

Ahmet Cumhur Dülger
0000-0002-9328-5185
Türkiye

Early Pub Date

February 15, 2026

Publication Date

February 15, 2026

Submission Date

November 25, 2025

Acceptance Date

February 12, 2026

Published in Issue

Year 2026 Number: Advanced Online Publication

DOI

https://doi.org/10.18621/eurj.1829791

IZ

https://izlik.org/JA72DT45XH

Cite

RIS / Bibtex

AMA

1.Günaydın S, Bektaş Aksoy H, Aksoy İ, Elmas A, Dülger AC. Factors Affecting Mortality in COVID-19 Pneumonia Patients Treated with Tocilizumab. Eur Res J. 2026;(Advanced Online Publication):1-9. doi:10.18621/eurj.1829791