Abstract
(1) Background: We aimed to analyze the characteristics associated with the in-hospital mortality, describe the early CT changes expressed quantitatively after tocilizumab (TOC), and assess TOC timing according to the oxygen demands. (2) Methods: We retrospectively studied 101 adult patients with severe COVID-19, who received TOC and dexamethasone. The lung involvement was assessed quantitatively using native CT examination before and 7–10 days after TOC administration. (3) Results: The in-hospital mortality was 17.8%. Logistic regression analysis found that interstitial lesions above 50% were associated with death (p = 0.01). The other variables assessed were age (p = 0.1), the presence of comorbidities (p = 0.9), the oxygen flow rate at TOC administration (p = 0.2), FiO2 (p = 0.4), lymphocyte count (p = 0.3), and D-dimers level (p = 0.2). Survivors had a statistically significant improvement at 7–10 days after TOC of interstitial (39.5 vs. 31.6%, p < 0.001), mixt (4.3 vs. 2.3%, p = 0.001) and consolidating (1.7 vs. 1.1%, p = 0.001) lesions. When TOC was administered at a FiO2 ≤ 57.5% (oxygen flow rate ≤ 13 L/min), the associated mortality was significantly lower (4.3% vs. 29.1%, p < 0.05). (4) Conclusions: Quantitative imaging provides valuable information regarding the extent of lung damage which can be used to anticipate the in-hospital mortality. The timing of TOC administration is important and FiO2 could be used as a clinical predictor.
Highlights
In patients hospitalized with severe and critical COVID-19, corticosteroids (CS) and immunomodulatory agents are essential therapeutic resources in order to block the cytokine storm
Some randomized clinical trials (RCTs) found that TOC does not change mortality, disease progression, or secondary infection rate (COVACTA, EMPACTA, BACC-Bay) [1–3], while others found an increase in survival rate, lower progression to mechanical ventilation (MV), and decrease in time to discharge, with no difference in secondary infection rates (CORIMUNO, RECOVERY, REMAP-CAP) [4–6]
We aimed to analyze the radiologic changes expressed quantitatively associated with the risk of in-hospital death among severe COVID-19 patients treated with CS plus TOC, we aimed to describe the CT changes at 7-10 days after TOC administration
Summary
In patients hospitalized with severe and critical COVID-19, corticosteroids (CS) and immunomodulatory agents are essential therapeutic resources in order to block the cytokine storm. Data from randomized clinical trials (RCTs), including patients with severe COVID-19, overall support the use of CS, but are inconsistent for TOC. A meta-analysis that included 27 RCTs found a significant mortality benefit in co-administering TOC and CS in patients with respiratory support, but not in those under MV, with better outcomes when given early in the course of the disease. While data suggest TOC was beneficial in the treatment of COVID-19 patients, it is unclear on what the optimum timing should be. These important studies involving patients treated with
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