Is Tocilizumab an effective therapy for Severe COVID-19: a retrospective cohort study

Sarfaraz, Samreen; Shaikh, Quratulain; Iftikhar, Sundus; Herekar, Fivzia; Saleem, Syed Ghazanfar; Kanani, Fatima

doi:10.21203/rs.3.rs-80146/v1

Cited by 2 publications

(3 citation statements)

References 19 publications

(26 reference statements)

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“…Some observational studies have reported mortality benefit of TCZ [37,38] but RCTs failed to demonstrate any difference in survival when compared to placebo or usual care [39]. Data from our center also did not show any survival benefit of TCZ [40]. The final model showed that the factors associated with mortality are older age, low oxygen saturation, high SOFA scores, raised pro-calcitonin, ICU admission and sepsis.…”

Section: Discussionmentioning

confidence: 75%

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Determinants of in-hospital mortality in COVID-19; a prospective cohort study from Pakistan

Sarfaraz

Shaikh

Saleem

et al. 2021

Preprint

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SummaryA prospective cohort study was conducted at the Indus Hospital Karachi, Pakistan between March and June 2020 to describe the determinants of mortality among hospitalized COVID-19 patients. 186 adult patients were enrolled and all-cause mortality was found to be 36% (67/186). Those who died were older and more likely to be males (p<0.05). Temperature and respiratory rate were higher among non-survivors while Oxygen saturation was lower (p<0.05). Serum CRP, D-dimer and IL-6 were higher while SpO2 was lower on admission among non-survivors (p<0.05). Non-survivors had higher SOFA and CURB-65 scores while thrombocytopenia, lymphopenia and severe ARDS was more prevalent among them (p<0.05). Use of non-invasive ventilation in emergency room, ICU admission and invasive ventilation were associated with mortality in our cohort (p<0.05). Length of hospital stay and days of intubation were longer in non-survivors (p<0.05). Use of azithromycin, hydroxychloroquine, steroids, tocilizumab, antibiotics, IVIG or anticoagulation showed no mortality benefit (p>0.05). Multivariable logistic regression showed that age > 60 years, oxygen saturation <93% on admission, pro-calcitonin > 2 ng/ml, unit rise in temperature and SOFA score, ICU admission and sepsis during hospital stay were associated with higher odds of mortality. Larger prospective studies are needed to further strengthen these findings.Key FindingsAge greater than 60 years is associated with in-hospital mortality among COVID-19 patientsOxygen saturation less than 93% and ICU admission are associated with higher odds of mortalityInflammatory markers including CRP, Ferritin and IL-6 were significantly higher among non-survivorsSerum pro-calcitonin greater than 2 ng/ml and sepsis during hospital stay are associated with higher odds of mortality among COVID-19 patients

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 80%

Determinants of in-hospital mortality in COVID-19; a prospective cohort study from Pakistan

Sarfaraz

Shaikh

Saleem

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…Some observational studies have reported mortality benefit of TCZ [ 40 , 41 ] but RCTs failed to demonstrate any difference in survival when compared to placebo or usual care [ 42 ]. Data from our center also did not show any survival benefit of TCZ [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Determinants of in-hospital mortality in COVID-19; a prospective cohort study from Pakistan

et al. 2021

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A prospective cohort study was conducted at the Indus Hospital Karachi, Pakistan between March and June 2020 to estimate the in-hospital mortality among hospitalized COVID-19 patients and its determinants. A total of 170 adult patients were enrolled and all-cause mortality was found to be 39% (67/170). Most non-survivors were above 60 years of age (64%) while gender distribution was quite similar in both groups (males: 77% vs 78%). Most (80.6%) non-survivors came with peripheral oxygen saturation less than 93% while 95% of them had critical disease on arrival. Use of non-invasive ventilation in emergency room was higher among non-survivors (56.7%) versus survivors (26.2%). Median Interleukin-6 levels were higher among non-survivors (78.6: IQR = 33.8–49.0) compared to survivors (21.8: IQR = 12.6–36.3). Most patients in the non-survivor group (86.6%) required invasive ventilator support during hospital stay compared to 7.8% in the survivors. The median duration of ICU stay was longer for non-survivors (9: IQR = 6–12) compared to survivors (5: IQR = 3–7) days. Univariable binary logistic regression showed that age above 60 years, oxygen saturation below 93%, Neutrophil to lymphocyte ratio above 5, procalcitonin above 2ng/ml, unit increase in SOFA score and arterial lactate levels were associated with mortality. We also found that a unit decrease in Pao2/FiO2 ratio and serum albumin were associated with mortality in our patients. Multivariable regression showed that age above 60 years (aOR = 3.4: 95% CI = 1.6–6.9), peripheral oxygen saturation below 93% (aOR = 3.5:95% CI = 1.6–7.7) and serum pro-calcitonin above 2ng/ml (aOR = 4.8; 95% CI = 1.9–12.2) were associated with higher odds of mortality when adjusted by month of admission. Most common cause of death was multisystem organ failure in 35 (56.6%) non-survivors while 22 (35.5%) died due to respiratory failure. Larger prospective studies are needed to further strengthen these findings.

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Is Tocilizumab an effective therapy for Severe COVID-19: a retrospective cohort study

Cited by 2 publications

References 19 publications

Determinants of in-hospital mortality in COVID-19; a prospective cohort study from Pakistan

Determinants of in-hospital mortality in COVID-19; a prospective cohort study from Pakistan

Determinants of in-hospital mortality in COVID-19; a prospective cohort study from Pakistan

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