Objectives

To describe the clinical characteristics and predictors of major outcomes in patients treated with tocilizumab (TCZ) for severe COVID-19 pneumonia.

Patients and methods

Case series of all sequential patients with severe COVID-19 pneumonia treated with TCZ at an Academic Spanish hospital (March 12 - May 2, 2020). Clinical outcomes: death, length of hospital stay. An early clinical response to TCZ (48-72 h after the administration) was assessed by variations in respiratory function markers, Brescia COVID Respiratory Severity Scale (BCRSS), inflammatory parameters, and patients' and physicians' opinion. Associations were tested by multiple logistic regression.

Results

From a cohort of 236 patients, 77 patients treated with TCZ were included (median age 62 years (IQR 53.0–72.0), 64.9% were males), 42.9% had Charlson index ≥3; hypertension (41.6%), obesity (34.7%), and diabetes (20.8%).

Median follow-up was 83.0 days (78.0–86.5), no patient was readmitted. ICU admission was required for 42 (54.5%), invasive mechanical ventilation in 38 (49.4%) and 10 patients died (12.9% global, 23.8% at ICU admitted). After multivariate adjustment, TCZ response by BCRSS (OR 0.03 (0.01–0.68), p = 0.028), and Charlson index (OR 3.54 (1.20–10.44), p = 0.022) has been identified as independent factors associated with mortality. Median of hospital stay was 16.0 days (11.0–23.0); BCRSS, physician subjective and D-dimer response were associated with shorter hospitalization stay.

Conclusions

In a Mediterranean cohort, use of tocilizumab for severe COVID-19 show 12.9% of mortality. Early TCZ-response by BCRSS and low comorbidity were associated with increased survival. Early TCZ-response was related to shorter median hospital stay.

中文翻译：

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随访80天后，使用Tocilizumab治疗严重COVID-19肺炎的经验：一项回顾性队列研究。

目标

要描述接受托珠单抗（TCZ）治疗的严重COVID-19肺炎患者的临床特征和主要结局指标。

患者和方法

西班牙学术医院（2020年3月12日至5月2日）接受TCZ治疗的所有重症COVID-19肺炎序贯患者的病例系列。临床结果：死亡，住院时间。TCZ的早期临床反应（给药后48-72小时）通过呼吸功能标志物，布雷西亚COVID呼吸严重程度量表（BCRSS），炎性参数以及患者和医生的意见进行评估。通过多重逻辑回归检验关联性。

结果

在236例患者中，包括77例接受TCZ治疗的患者（中位年龄62岁（IQR 53.0-72.0），男性占64.9％），查尔森指数≥3的占42.9％；高血压（41.6％），肥胖症（34.7％）和糖尿病（20.8％）。

中位随访时间为83.0天（78.0-86.5），无患者再次入院。42例（54.5％）的患者需要接受ICU入院，38例（49.4％）的患者需要进行有创机械通气，而10例患者死亡（全球12.9％，ICU入院时为23.8％）。经过多变量调整后，已确定BCRSS的TCZ响应（OR 0.03（0.01–0.68），p = 0.028）和Charlson指数（OR 3.54（1.20-10.44），p = 0.022）被确定为与死亡率相关的独立因素。住院中位时间为16.0天（11.0-23.0）；BCRSS，医师主观和D-二聚体反应与住院时间短有关。

结论

在地中海队列中，使用托珠单抗治疗严重的COVID-19会导致12.9％的死亡率。BCRSS早期的TCZ反应和低合并症与存活率增加相关。早期TCZ反应与中位住院时间短有关。