Beneficial effect of corticosteroids in preventing mortality in patients receiving tocilizumab to treat severe COVID-19 illness

Objectives: To assess the characteristics and risk factors for mortality in patients with severe coronavirus disease-2019 (COVID-19) treated with tocilizumab (TCZ), alone or in combination with corticosteroids (CS). Methods: From March 17 to April 7, 2020, a real-world observational retrospective an...

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Detalles Bibliográficos
Autores: Rubio-Rivas, Manuel, Ronda, Mar, Padullés, Ariadna, Mitjavila, Francesca, Riera-Mestre, Antoni, García-Forero, Carlos, Iriarte, Adriana, Mora-Luján, José María, Padullés, Núria, Gonzalez, Monica, Solanich, Xavier, Gasa, Merce, Suarez-Cuartin, Guillermo, Sabater-Riera, Joan, Perez-Fernandez, Xose L., Santacana, Eugenia, Leiva, Elisabet, Ariza-Sole, Albert, Dallaglio, Paolo D., Quero, Maria, Soriano, Antonio, Pasqualetto, Alberto, Koo, Maylin, Esteve-Luque, Virginia, Antolí, Arnau, Moreno-Gónzalez, Rafael, Yun, Sergi, Cerdà, Pau, Llaberia, Mariona, Formiga, Francesc, Fanlo-Maresma, Marta, Montero, Abelardo, Chivite, David, Capdevila, Olga, Bolao, Ferran, Pintó, Xavier, Llop, Josep, Sabate, Antoni, Guardiola, Jordi, Cruzado, Josep M., Comin-Colet, Josep, Santos, Salud, Jodar, Ramon, Corbella Virós, Xavier
Tipo de recurso: artículo
Fecha de publicación:2020
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:20.500.12328/1846
Acceso en línea:http://hdl.handle.net/20.500.12328/1846
https://dx.doi.org/10.1016/j.ijid.2020.09.1486
Access Level:acceso abierto
Palabra clave:Esteroides
Corticosteroides
COVID-19 (Malaltia)
Mortalitat
COVID-19
Mortalidad
Steroids
Corticosteroids
Mortality
61
616.9
Descripción
Sumario:Objectives: To assess the characteristics and risk factors for mortality in patients with severe coronavirus disease-2019 (COVID-19) treated with tocilizumab (TCZ), alone or in combination with corticosteroids (CS). Methods: From March 17 to April 7, 2020, a real-world observational retrospective analysis of consecutive hospitalized adult patients receiving TCZ to treat severe COVID-19 was conducted at our 750-bed university hospital. The main outcome was all-cause in-hospital mortality. Results: A total of 1,092 patients with COVID-19 were admitted during the study period. Of them, 186 (17%) were treated with TCZ, of which 129 (87.8%) in combination with CS. Of the total 186 patients, 155 (83.3 %) patients were receiving noninvasive ventilation when TCZ was initiated. Mean time from symptoms onset and hospital admission to TCZ use was 12 (±4.3) and 4.3 days (±3.4), respectively. Overall, 147 (79%) survived and 39 (21%) died. By multivariate analysis, mortality was associated with older age (HR = 1.09, p < 0.001), chronic heart failure (HR = 4.4, p = 0.003), and chronic liver disease (HR = 4.69, p = 0.004). The use of CS, in combination with TCZ, was identified as a protective factor against mortality (HR = 0.26, p < 0.001) in such severe COVID-19 patients receiving TCZ. No serious superinfections were observed after a 30-day follow-up. Conclusions: In patients with severe COVID-19 receiving TCZ due to systemic host-immune inflammatory response syndrome, the use of CS in addition to TCZ therapy, showed a beneficial effect in preventing in-hospital mortality.

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