tetano
Editor, Senior Moderator
Crit Care Explor
. 2021 Mar 29;3(4):e0395.
doi: 10.1097/CCE.0000000000000395. eCollection 2021 Apr.
Early Tocilizumab Dosing Is Associated With Improved Survival in Critically Ill Patients Infected With Severe Acute Respiratory Syndrome Coronavirus-2
Russell M Petrak[SUP] 1 [/SUP], Nicholas W Van Hise[SUP] 1 [/SUP], Nathan C Skorodin[SUP] 1 [/SUP], Robert M Fliegelman[SUP] 1 [/SUP], Vishnu Chundi[SUP] 1 [/SUP], Vishal Didwania[SUP] 1 [/SUP], Alice Han[SUP] 1 [/SUP], Brian P Harting[SUP] 1 [/SUP], David W Hines[SUP] 1 [/SUP]
Affiliations
Abstract
To identify the most efficacious timing for tocilizumab administration in critically ill patients infected with severe acute respiratory syndrome coronavirus-2.
Design: Observational multicenter cohort study.
Setting: A total of 23 acute care hospitals in four states.
Patients: One-hundred eighteen patients admitted between March 13, 2020, and April 16, 2020. Eighty-one patients received tocilizumab, and 37 were untreated and served as a control group.
Measurements and main results: The main outcome was mortality and was analyzed by timing of tocilizumab dosing. Early dosing was defined as a tocilizumab dose administered prior to or within 1 day of intubation. Late dosing was defined as a dose administered greater than 1 day after intubation. A control group that was treated only with standard of care, and without tocilizumab, was used for comparison. Early tocilizumab therapy was associated with a statistically significant decrease in mortality as compared to patients who were untreated (p = 0.003). Dosing tocilizumab late was associated with an increased mortality compared with the untreated group (p = 0.006).
Conclusions: Early tocilizumab administration was associated with decreased mortality in critically ill severe acute respiratory syndrome coronavirus-2 patients, but a potential detriment was suggested by dosing later in a patient's course.
Keywords: cytokine storm; mechanical ventilation; mortality; severe acute respiratory syndrome coronavirus-2; tocilizumab.
. 2021 Mar 29;3(4):e0395.
doi: 10.1097/CCE.0000000000000395. eCollection 2021 Apr.
Early Tocilizumab Dosing Is Associated With Improved Survival in Critically Ill Patients Infected With Severe Acute Respiratory Syndrome Coronavirus-2
Russell M Petrak[SUP] 1 [/SUP], Nicholas W Van Hise[SUP] 1 [/SUP], Nathan C Skorodin[SUP] 1 [/SUP], Robert M Fliegelman[SUP] 1 [/SUP], Vishnu Chundi[SUP] 1 [/SUP], Vishal Didwania[SUP] 1 [/SUP], Alice Han[SUP] 1 [/SUP], Brian P Harting[SUP] 1 [/SUP], David W Hines[SUP] 1 [/SUP]
Affiliations
- PMID: 33817660
- PMCID: PMC8009634
- DOI: 10.1097/CCE.0000000000000395
Abstract
To identify the most efficacious timing for tocilizumab administration in critically ill patients infected with severe acute respiratory syndrome coronavirus-2.
Design: Observational multicenter cohort study.
Setting: A total of 23 acute care hospitals in four states.
Patients: One-hundred eighteen patients admitted between March 13, 2020, and April 16, 2020. Eighty-one patients received tocilizumab, and 37 were untreated and served as a control group.
Measurements and main results: The main outcome was mortality and was analyzed by timing of tocilizumab dosing. Early dosing was defined as a tocilizumab dose administered prior to or within 1 day of intubation. Late dosing was defined as a dose administered greater than 1 day after intubation. A control group that was treated only with standard of care, and without tocilizumab, was used for comparison. Early tocilizumab therapy was associated with a statistically significant decrease in mortality as compared to patients who were untreated (p = 0.003). Dosing tocilizumab late was associated with an increased mortality compared with the untreated group (p = 0.006).
Conclusions: Early tocilizumab administration was associated with decreased mortality in critically ill severe acute respiratory syndrome coronavirus-2 patients, but a potential detriment was suggested by dosing later in a patient's course.
Keywords: cytokine storm; mechanical ventilation; mortality; severe acute respiratory syndrome coronavirus-2; tocilizumab.