In cases of COVID-19 acute respiratory distress syndrome, an excessive host inflammatory response has been reported, with elevated serum interleukin-6 levels. In this multicenter retrospective cohort study we included adult patients with COVID-19, need of respiratory support, and elevated C-reactive protein who received intravenous tocilizumab in addition to standard of care. Control patients not receiving tocilizumab were matched for sex, age and respiratory support. We selected survival as the primary endpoint, along with need for invasive ventilation, thrombosis, hemorrhage, and infections as secondary endpoints at 30 days. We included 64 patients with COVID-19 in the tocilizumab group and 64 matched controls. At baseline the tocilizumab group had longer symptom duration (13 ± 5 vs. 9 ± 5 days) and received hydroxychloroquine more often than controls (100% vs. 81%). The mortality rate was similar between groups (27% with tocilizumab vs. 38%) and at multivariable analysis risk of death was not significantly influenced by tocilizumab (hazard ratio 0.61, 95% confidence interval 0.33–1.15), while being associated with the use at baseline of non invasive mechanical or invasive ventilation, and the presence of comorbidities. Among secondary outcomes, tocilizumab was associated with a lower probability of requiring invasive ventilation (hazard ratio 0.36, 95% confidence interval 0.16–0.83; P = 0.017) but not with the risk of thrombosis, bleeding, or infections. The use of intravenous tocilizumab was not associated with changes in 30-day mortality in patients with COVID-19 severe respiratory impairment. Among the secondary outcomes there was less use of invasive ventilation in the tocilizumab group.

在COVID-19急性呼吸窘迫综合征的病例中，已经报道了过度的宿主炎症反应，血清白介素6水平升高。在这项多中心回顾性队列研究中，我们纳入了接受COVID-19，需要呼吸支持和C反应蛋白升高的成年患者，这些患者除接受标准护理外还接受静脉注射tocilizumab治疗。未接受托珠单抗的对照患者在性别，年龄和呼吸支持方面均匹配。我们选择生存作为主要终点，并选择有创通气，血栓形成，出血和感染作为30天的次要终点。我们将64例COVID-19的患者纳入tocilizumab组和64例匹配的对照组。在基线时，tocilizumab组的症状持续时间较长（13±5vs。9±5天）和接受羟氯喹的频率高于对照组（100％比81％）。两组之间的死亡率相似（托珠单抗为27％，而38％），多变量分析显示，死亡风险不受托珠单抗显着影响（危险比0.61，95％置信区间0.33-1.15），但与使用有关在无创机械或有创通气的基线，以及是否存在合并症。在次要结局中，托​​珠单抗与需要有创通气的可能性较低（危险比0.36，95％置信区间0.16-0.83； P = 0.017），但与血栓形成，出血或感染的风险无关。静脉使用Tocilizumab与COVID-19严重呼吸功能不全患者30天死亡率的变化无关。