Abstract
BackgroundCritical coronavirus disease 2019 (COVID-19) has a high fatality rate, especially in hemodialysis (HD) patients, with this poor prognosis being caused by systemic hyperinflammation; cytokine storms. Steroid pulse therapy or tocilizumab (TCZ) have insufficient inhibitory effects against cytokine storms in critical cases. This study evaluated the clinical effects and safety of combining steroid pulse therapy and TCZ.MethodsFrom September 2020 to May 2021, 201 patients with COVID-19 were admitted to our hospital. Before February 2021, patients with an oxygen demand exceeding 8 L/min were intubated and treated with standard therapy (dexamethasone and antiviral therapy). After February 2021, patients underwent high-flow nasal cannula oxygen therapy and were treated with TCZ (8 mg/kg) and methylprednisolone (mPSL) (500 mg/day [≤ 75 kg], 1000 mg/day [> 75 kg]) for 3 days. We compared background characteristics, laboratory findings, and prognosis between non-HD and HD patients and between patients who received and did not receive TCZ and mPSL pulse therapy.ResultsAmong non-HD patients, the TCZ + mPSL pulse group had significantly higher survival rates and lower secondary infection rates (p < 0.05), than the standard therapy group. All HD patients in the standard therapy group with oxygen demand exceeding 8 L/min died. Contrastingly, all patients in the TCZ + mPSL pulse group survived, with their oxygen demand decreasing to 0–1 L/min within 3 weeks post-administration.ConclusionTCZ combined with mPSL pulse therapy improved the survival rate without significant adverse events in critical HD and non-HD patients with COVID-19 by strongly suppressing systemic hyperinflammation.
Highlights
In December 2019, the first case of coronavirus disease 2019 (COVID-19), which is caused by the novel severe acute respiratory syndrome coronavirus 2, was reported in Wuhan, China; subsequently, it has dramatically spread worldwide
There are numerous active studies on effective treatments for COVID-19, with dexamethasone [2] and remdesivir [3] being currently recommended as standard therapy based on COVID-19 treatment guidelines published by the National Institutes of Health
Among 190 non-HD patients with COVID-19 admitted to our hospital from September 2020 to May 2021, 17 cases showed an oxygen demand exceeding 8 L/min
Summary
In December 2019, the first case of coronavirus disease 2019 (COVID-19), which is caused by the novel severe acute respiratory syndrome coronavirus 2, was reported in Wuhan, China; subsequently, it has dramatically spread worldwide. All patients in the TCZ + mPSL pulse group showed a marked decrease in C-reactive protein (CRP) levels immediately after treatment, which reached almost zero in all patients within 2 weeks. TCZ tocilizumab, mPSL methylprednisolone, HFNC high-flow nasal cannula, CRP c-reactive protein, LDH lactate dehydrogenase standard therapy group, three patients whose oxygen demand exceeded 8 L/min required respiratory management (two underwent HFNC therapy and one was intubated) while six patients were treated using oxygen masks alone. Among patients who received respiratory management, there was no between-group difference in background characteristics, comorbidities, or days from onset to oxygen demand exceeding 8 L/min; further, laboratory findings at admission were slightly worse in the standard therapy group while the duration from onset to hospitalization was longer in the TCZ + mPSL pulse group (Table 4). Median days to O 2 8 L (IQR) Any Diabetes Hypertention Hyperlipidemia Malignancy
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