Abstract
AimAs Coronavirus Disease-2019 (COVID-19) pandemic continues to evolve, the search for safe and effective therapeutic interventions remain essential.MethodsWe conducted a retrospective cohort study on patients hospitalized with laboratory confirmed severe acute respiratory syndrome coronavirus-2 infection, comparing standard of care along with Convalescent Plasma with or without Tocilizumab (CP vs. CPT).ResultsA total of 110 patients were enrolled with an overall mean age of 50 ± 16 years. Patients on CPT were more likely to have had acute respiratory distress syndrome (77% vs. 42%; p < 0.001), sepsis (9.7% vs. 0; p = 0.036), chest X-ray abnormalities (71% vs. 44%; p = 0.004), intensive care unit admission (84% vs. 56%; p = 0.001) as well as being on mechanical ventilation (79% vs. 48%; p = 0.001). After CPT treatment, all measured inflammatory markers, except interleukine-6, showed an overall steady decline over time (all p-values <0.05) and the ventilatory parameters showed significant improvement of PaO2/FiO2 ratio from 127 to 188 within 7 days (p < 0.001). Additionally, 52% (32/62) of the patients had favorable outcome, either as improvement of ventilatory parameters or extubation within 14 days of hospitalization. However, mortality rate in those on CPT was higher than those who received CP alone (24% vs. 8.3%; p = 0.041).ConclusionIn patients with severe COVID-19 infection, using tocilizumab with convalescent plasma is associated with improvement in inflammatory and ventilatory parameters but no effect on mortality. These findings require validation from randomized clinical trials.
Highlights
Since December, 2019, a novel coronavirus named Severe Acute Respiratory Syndrome-2 (SARS-CoV-2) causing Coronavirus Disease-2019 (COVID-19) has been spreading rapidly causing significant morbidity and mortality worldwide
Patients admitted with severe COVID-19 infection in the Intensive Care Units (ICU) tend to have higher levels of inflammatory cytokines, including: Tumor Necrosis Factor a (TNF-a), Interleukins (IL) 2, 6, 7, and 10, Granulocyte-Colony Stimulating Factor (G-CSF), monocyte chemoattractant protein 1, macrophage inflammatory protein 1 alpha, and interferon-γ-inducible protein 10; an aberrant host immune response suggesting a “cytokine storm”
The aim of this study was to assess the role of tocilizumab in improving outcomes including mortality, in a cohort of patients with severe COVID-19 pneumonia who received standard of care treatment and Convalescent Plasma (CP)
Summary
Since December, 2019, a novel coronavirus named Severe Acute Respiratory Syndrome-2 (SARS-CoV-2) causing Coronavirus Disease-2019 (COVID-19) has been spreading rapidly causing significant morbidity and mortality worldwide. The clinical presentation of COVID-19 is highly variable, ranging from asymptomatic to severe pneumonia, Acute Respiratory Distress Syndrome (ARDS) that may progress rapidly to respiratory failure, and even requiring invasive Mechanical Ventilation (MV). Identifying risk factors for mortality and developing vaccines and novel therapeutics of severe COVID-19 is extremely important more than ever as the pandemic is still ongoing despite global efforts. F. Khamis et al / Journal of Epidemiology and Global Health 11(2) 216–223 that causes increased alveolar exudate hindering the alveolar gas exchange [2,3] and contributes to the high mortality associated with severe COVID-19 infection [4]
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