Effect of Tocilizumab in Terms of Hospital Stay and Mortality Pattern Among Patients with Severe Versus Critically-ill COVID-19 Patients: A Comparative Analytic Study

Abstract

Background and Objectives: Most patients with mild and moderate COVID-19 infection recover with standard care therapy. Mortality in patients with severe illness and those critically ill is high. Tocilizumab acts by blocking interleukin-6 receptors and shows promising results in severe disease. Aim of this study was to assess the effect of Tocilizumab in severe and critically ill COVID-19 patients in terms hospital stay and reducing the risk of death. Methods: In this comparative analytical, single-center study undertaken in DHQ university teaching hospital Gujranwala, forty-four patients were enrolled after an informed consent through non-probability consecutive sampling. The patients were categorized based on oxygen requirement as severe (oxygen requirement 10 L/min) and critically ill patients (oxygen requirement 15 L/min). All patients were treated with injection Tocilizumab (8mg per kg body weight) using criteria based on oxygen requirement (10L/min or more) and increased levels of any two of the laboratory investigations including CRP, D-Dimers, serum ferritin and LDH. Sociodemographic and clinical profile were collected using a semi-structured proforma. Outcome of interest was hospital stay and mortality. Comparison of effect of Tocilizumab was analyzed in regards to age, sex, laboratory investigations and stated outcome using Pearson's Chi-squared test. P-value of ≤0.05 was considered statistically significant. Data were analyzed using SPSS version 24.0. Results: Of 44 COVID-19 patients, 26 (59.1%) had severe disease and 18 (40.9%) were critically ill. We did not observe any statistical difference between these two categories as regards age, sex, hospital stay or presence of co-morbid conditions. However, there were 17 (94%) deaths observed among critically ill patients, while one patient died with severe disease. This mortality difference was found statistically significant (p<0.001). Conclusion: Tocillizumab has shown significant effect to reduce mortality and minimizing hospital stay amongst COVID-19 patients with severe disease only with minimal effect in critically ill patients. Tocilizumab may be introduced early in treatment plan for severe COVID-19 patients.