Predictors of Mortality in Severe and Critical COVID-19 Patients Receiving High Dose Intravenous Anakinra

Öz

Objective: In this study, we aim to evaluate the predictive factors associated with mortality in patients with severe and critical COVID-19 receiving high dose intravenous anakinra. Methods: This is an observational retrospective study was conducted at a tertiary referral center between 01.09.2021 and 01.02.2022 in Turkey. COVID-19 disease severity was evaluated according to National Institute of Health (NIH) severity scale. Inflammatory state of the patients was calculated according to COVID hyperinflammatory syndrome (cHIS) score. Clinical (patients characteristics, disease severity, inflammatory state) and laboratory parameters such as lymphocyte count, CRP, LDH, ferritin and d-dimer levels were compared in patients had mortality and those had not. Results: Data of 148 patients (n=78; 53% male) were analyzed. Mean±standard deviation (SD) patient age was 66.8±17 years and median (interquartile of range; IQR) duration of hospitalization was 11 (12) days. In this cohort, 57 patients (38.5%) severe, 91 patients (61.5%) had critical disease and mean±SD cHIS score was 3.4±1.2. Overall, 56 patients (37.8%) died during the follow-up and ICU admission was in 60 patients (40.5%) and intubation was in 54 patients (36.5%). Conclusion: In our study mortality was developed in third of anakinra receiving severe and critical ill COVID-19 patients. Mortality was independently associated with advanced age, critical illness and higher cHIS score reflecting higher inflammatory burden. Furthermore, highest levels of CRP, LDH, ferritin, D-dimer and higher cHIS score predict higher mortality in patients with COVID-19 receiving anakinra.

Anahtar Kelimeler

• COVID 19
• Anakinra
• Cytokine Storm
• Hyperinflammation
• Predictors

Yüksek Doz İntravenöz Anakinra Alan Ciddi ve Kritik COVİD-19 Hastalarında Mortalite Öngördürücüleri

Öz

Amaç: Bu çalışmada, yüksek doz intravenöz anakinra alan ciddi ve kritik COVID-19 hastalarında mortalite ile ilişkili öngörücü faktörleri değerlendirmeyi amaçladık. Yöntem: Bu çalışma, 01.09.2021 ile 01.02.2022 tarihleri arasında üçüncü basamak referans merkezinde gerçekleştirilmiştir. Çalışmamız geriye dönük gözlemsel bir çalışmadır. COVID-19 hastalık şiddeti NIH şiddet ölçeğine göre değerlendirildi. COVID hiperinflamatuar sendrom (cHIS) skoru hastaların inflamatuvar durumlarını değerlendirmek için hesaplandı. Klinik (hasta özellikleri, hastalık şiddeti, inflamatuvar durum) ve laboratuvar parametreleri (lenfosit sayısı, CRP, LDH, ferritin ve d-dimer düzeyleri) mortalite gerçekleşen ve gerçekleşmeyen hastalarda karşılaştırıldı. Bulgular: 148 hastanın (n=78; %53 erkek) verileri analiz edildi. Ortalama±standart sapma (SS) hasta yaşı 66.8±17 yıl ve ortanca (çeyrekler arası aralık; IQR) hastanede kalış süresi 11 (12) gündü. Bu kohortta 57 hasta (%38.5) şiddetli, 91 hasta (%61.5) kritik hastalığa sahipti ve hastaların ortalama±SD cHIS skoru 3.4±1.2 idi. Toplamda 56 hastada (%37.8) takip sırasında mortalite gerçekleşti ve 60 hastada (%40.5) yoğun bakım ünitesine yatış ve 54 hastada (%36.5) entübasyon ihtiyacı oluştu. Sonuç: Çalışmamızda ciddi ve kritik seyirli COVİD-19 hastalarının yaklaşık üçte birinde mortalite gerçekleşmiştir. Mortalite hızı ileri hasta yaşı, kritik hastalık şiddeti ve inflamatuvar yükü yansıtan cHIS skoru ile ilişkili bulundu. Dahası, yüksek CRP, LDH, ferritin, d-dimer seviyeleri ve cHIS skoru anakinra alan COVİD-19 hastalarında yüksek mortaliteyi öngördürmekteydi

Anahtar Kelimeler

• COVİD-19
• Anakinra
• Sitokin Fırtınası
• Hiperinflamasyon
• Öngördürücüler

Kaynakça

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