Characteristics of patients administered tocilizumab for COVID-19 pneumonia

Yıl 2024, Cilt: 38 Sayı: 1, 95 - 107, 23.07.2024

Levent Özdemir , Burcu Özdemir Mehmet Murat Çelik , Senem Urfalı , Bilge Akgündüz Savaş Gegin

Bu makale için 23 Temmuz 2024 tarihinde bir düzeltme yayımlandı. https://dergipark.org.tr/tr/pub/ighd/issue/84984/1549928

Öz

Aim
Determination of the characteristics of patients who developed macrophage activation syndrome(MAS) due to Sars-Cov2(COVID-19) pneumonia and were treated with tocilizumab.
Material and Methods
Demographic data of 38 patients with COVID-19 pneumonia who developed MAS due to respiratory failure who were treated with tocilizumab in the intensive care unit between November 2020 and September 2021 were evaluated.The comorbidities of the patients, length of stay in the hospital and intensive care unit, survival status, the day of tocilizumab administration, the frequency of secondary infection after tocilizumab, and the laboratory values of the patients who survived and exited in patients treated with tocilizumab were compared before and on the third day after the application.
Results
38 patients were included in the study.27 of the patients were men and 11 were women.The average age was 59.6±11.5. There were comorbidities in 29 patients. Hypertension, diabetes and asthma were most frequently detected.
It was observed that 18 of the patients receiving tocilizumab treatment survived and 20(52.6%) exited.The hospital stay of patients treated with tocilizumab was 18.8±9.1 days in the surviving group and 15.9±7.6days in the exitus group.The duration of stay in the intensive care unit was 11.3±6.6 days in the group that survived and 13.9±7.8days in the group with exitus. The time from admission to the day of administration of tocilizumab was 5.8±3 days in the surviving group and 7.3±4.3days in the exitus group.
Secondary infection was detected in seven patients after tocilizumab.On the third day of treatment, it was determined that LDH,D-dimer, and neutrophil percentage decreased, while the number and percentage of lymphocytes increased.
We found that mortality is high in patients who develop MAS and that the decrease in LDH,D-dimer, neutrophil percentage and increase in lymphocyte number and percentage in the early period in patients treated with tocilizumab may be indicators of survival.

Anahtar Kelimeler

COVID-19, tocilizumab, laboratory parameter, mortality

COVID-19 pnömonisi nedeni ile tosilizumab uygulanan hastaların özellikleri

Bu makale için 23 Temmuz 2024 tarihinde bir düzeltme yayımlandı. https://dergipark.org.tr/tr/pub/ighd/issue/84984/1549928

Öz

1Samsun Eğitim Ve Araştırma Hastanesi, Göğüs Hastalıkları, Samsun
2Dörtyol Devlet Hastanesi, Anestezi ve Reanimasyon, Hatay, Türkiye
3Mustafa Kemal Üniversitesi Tıp Fakültesi, Anestezi ve Reanimasyon, Hatay, Türkiye
4Eskişehir Şehir Hastanesi Meslek Hastalıkları Kliniği, Eskişehir, Türkiye

Amaç
Sars-Cov2 (COVID-19) pnömonisi nedeni ile makrofaj aktivasyon sendromu(MAS) gelişen ve tedavide tosilizumab uygulanan hastaların özelliklerinin belirlenmesi
Gereç ve Yöntem
Kasım 2020-eylül 2021 tarihleri arasında yoğun bakım ünitesinde COVID-19 pnömonisine bağlı solunum yetmezliği nedeni MAS gelişen ve tedavide tosilizumab uygulanan 38 hastanın demografik verileri değerlendirildi. Hastaların komorbiditeleri, hastanede ve yoğun bakımda yatış süreleri, sağkalım durumları, tosilizumabın uygulandığı gün, tosilizumab sonrası sekonder enfeksiyon sıklığı ile tosilizumab uygulanan hastalarda yaşayan ve exitus olan hastaların tedavi öncesi ve uygulandıktan sonraki üçüncü gün laboratuvar değerleri karşılaştırıldı
Bulgular
Çalışmaya 38 hasta alındı. Hastaların 27’si erkek, 11’i kadındı. Yaş ortalaması 59,6±11,5 idi. 29 hastada komorbidite mevcuttu. En sık hipertansiyon, diyabet, astım saptandı.
Tosilizumab tedavisi alan hastaların 18’sinin yaşadığı, 20’sinin (%52,6) exitus olduğu görüldü. Tosilizumab uygulanan hastaların hastanede kalış süresi yaşayan grupta 18,8 ± 9,1 gün, ex olan grupta 15,9 ± 7,6 gün idi. Yoğun bakımda kalma süresi yaşayan grupta 11,3 ± 6,6 gün, exitus olan grupta 13,9 ± 7,8 gün idi. Tosilizumabın yatışdan uygulanma gününe kadar geçen süre yaşayan grupta 5,8 ± 3 gün, exitus olan grupta 7,3 ± 4,3 gün idi
Tosilizumab sonrası yedi hastada sekonder enfeksiyon saptandı. Tedavinin üçüncü gününde laktat dehidrojenaz (LDH), D-dimer, nötrofil yüzdesinin azaldığı, lenfosit sayısı ve yüzdesi arttığı saptandı
Sonuç
MAS gelişen hastalarda mortalitenin yüksek olduğu ve tosilizumab tedavisi uygulanan hastalarda erken dönemde LDH, D-dimer, nötrofil yüzdesinin azalmasının, lenfosit sayısı ve yüzdesinin artmasının yaşam göstergesi olabileceğini saptadık.
Anahtar Kelimeler: COVID-19, tosilizumab, laboratuvar parametre, mortalite

Anahtar Kelimeler

COVID-19, tosilizumab, laboratuvar parametre, mortalite

Etik Beyan

var

Kaynakça

• 1. Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknownetiology in Wuhan China: the mystery and the miracle.J MedVirol 2020;92 (4):401-2.
• 2. Wei Q, Lin H, Wei RG, Chen N, He F, Zou DH, et al. Tocilizumab treatment for COVID-19 patients: a systematic review and meta-analysis. Infect Dis Poverty 2021 18;10(1):71.
• 3. Del Valle DM, Kim-Schulze S, Huang HH, Beckmann ND, Nirenberg S, Wang B, et al. An inflammatory cytokine signature predicts COVID-19 severity and survival. Nat Med 2020; 26:1636–43
• 4. Zhang J, Hao Y, Ou W, Ming F, Liang G, Qian Y, et al. Serum interleukin-6 is an indicator for severity in 901 patients with SARS-CoV-2 infection: a cohort study. J Trans Med 2020;18:406.
• 5. Toniati P, Piva S, Cattalini M, Garrafa E, Regola F, Castelli F, et al. Tocilizumabforthetreatment of severe COVID-19 pneumonia with hyperinflammatory syndrome and acute respiratory failure: a single center study of 100 patients in Brescia, Italy. AutoimmunRev 2020; 19:102568
• 6. Yakar Hİ, Pazarlı AC, İnönü Köseoğlu H, Kanbay A. Theeffect of tocilizumab on severe COVID-19 infection. TuberkToraks 2021;69(1):74-83
• 7. T.C. Sağlık Bakanlığı. (2020). COVID-19 (SARS-CoV-2 Enfeksiyonu) Rehberi. https://covid19bilgi.saglik.gov.tr/depo/rehberler/COVID- 19_Rehberi.pdf (Erişim Tarihi: 9 Ekim 2020)
• 8. Li J, Huang DQ, Zou B, Yang H, Hui WZ, Rui F, et al. Epidemiology of COVID-19: A systematic review and meta-analysis of clinical characteristics, risk factors, and outcomes. J Med Virol 2021;93(3):1449-58.
• 9. Capra R, De Rossi N, Mattioli F, Romanelli G, Scarpazza C, Sormani MP, et al. Impact of low dose tocilizumab on mortality rate in patients with COVID-19 related pneumonia. Eur J Intern Med 2020; 76:31-35
• 10. Klopfenstein T, Zayet S, Lohse A, Balblanc JC, Badie J, Royer PY, et al. HNF Hospital Tocilizumab multidisciplinary team. Tocilizumab therapy reduced intensive care unit admissions and/or mortality in COVID-19 patients. Med Mal Infect 2020;50(5):397
• 11. Ramaswamy M, Mannam P, Comer R, Sinclair E, McQuaid DB, Schmidt ML. Off-label real world exitus perience using tocilizumab for patients hospitalized with COVID-19 disease in a regional community health system: a case–control study. medRxiv. 2020 May 19
• 12. Rezaei Tolzali MM, Noori M, Shokri P, Rahmani S, Khanzadeh S, Nejadghaderi SA, et al. Efficacy of tocilizumab in the treatment of COVID-19: An umbrella review. Rev Med Virol 2022;32(6): e2388
• 13. Chen CC, Yang YP, Tsai HL, Tung TH. Effects of Tocilizumab on Adults With COVID-19 Pneumonia: A Meta-Analysis. Front Med (Lausanne) 2022 30;9: 838904
• 14. Chober D, Aksak-Wąs B, Bobrek-Lesiakowska K, Budny-Finster A, Hołda E, Mieżyńska-Kurtycz J, et al. Effectiveness of Tocilizumab in Patients with Severe or Critical Lung Involvement in COVID-19: A Retrospective Study. J Clin Med 2022 20;11(9):2286.
• 15. Kaya S, Kavak S. Efficacy of Tocilizumab in COVID-19: Single-Center Exitus perience. Biomed Res Int 2021 30;2021: 1934685
• 16. Knorr JP, Colomy V, Mauriello CM, Ha S. Tocilizumab in patients with severe COVID-19: A single-center observational analysis. J Med Virol 2020;92(11):2813-20.
• 17. Somers EC, Eschenauer GA, Troost JP, Golob JL, Gandhi TN, Wang L, et al. Tocilizumab for Treatment of Mechanically Ventilated Patients With COVID-19. Clin Infect Dis 2021 15;73(2): e445-54
• 18. Ivan Hariyanto T, Kurniawan A. Tocilizumab administration is associated with the reduction in biomarkers of coronavirus disease 2019 infection. J Med Virol 2021;93(3):1832-36.
• 19. Tanrıverdi M, Gündoğdu G. Association of Changes in Inflammatory Markers with Mortality in COVID-19 Infection Treated with Tocilizumab. Kocaeli Med J 2022;11(3)254-302