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- Title
Predictors of Mortality in Tocilizumab-Treated Severe COVID-19.
- Authors
Pagkratis, Konstantinos; Chrysikos, Serafeim; Antonakis, Emmanouil; Pandi, Aggeliki; Kosti, Chrysavgi Nikolaou; Markatis, Eleftherios; Hillas, Georgios; Digalaki, Antonia; Koukidou, Sofia; Chaini, Eleftheria; Afthinos, Andreas; Dimakou, Katerina; Papanikolaou, Ilias C.
- Abstract
Purpose: Tocilizumab is associated with positive outcomes in severe COVID-19. We wanted to describe the characteristics of nonresponders to treatment. Methods: This was a retrospective multicenter study in two respiratory departments investigating adverse outcomes at 90 days from diagnosis in subjects treated with tocilizumab (8 mg/kg intravenously single dose) for severe progressive COVID-19. Results: Of 121 subjects, 62% were males, and 9% were fully vaccinated. Ninety-six (79.4%) survived, and 25 died (20.6%). Compared to survivors (S), nonsurvivors (NS) were older (median 57 versus 75 years of age), had more comorbidities (Charlson comorbidity index 2 versus 5) and had higher rates of intubation/mechanical ventilation (p < 0.05). On admission, NS had a lower PO2/FiO2 ratio, higher blood ferritin, and higher troponin, and on clinical progression (day of tocilizumab treatment), NS had a lower PO2/FiO2 ratio, decreased lymphocytes, increased neutrophil to lymphocyte ratio, increased ferritin and lactate dehydrogenase (LDH), disease located centrally on computed tomography scan, and increased late c-reactive protein. Cox proportional hazards regression analysis identified age and LDH on deterioration as predictors of death; admission PO2/FiO2 ratio and LDH as predictors of intubation; PO2/FiO2 ratios, LDH, and central lung disease on radiology as predictors of noninvasive ventilation (NIV) (a < 0.05). The log-rank test of mortality yielded the same results (p < 0.001). ROC analysis of the above predictors in a separate validation cohort yielded significant results. Conclusions: Older age and high serum LDH levels are predictors of mortality in tocilizumab-treated severe COVID-19 patients. Hypoxia levels, LDH, and central pulmonary involvement radiologically are associated with intubation and NIV.
- Subjects
NEUTROPHIL lymphocyte ratio; COVID-19; NONINVASIVE ventilation; LACTATE dehydrogenase; VACCINATION status
- Publication
Vaccines, 2022, Vol 10, Issue 6, pN.PAG
- ISSN
2076-393X
- Publication type
Article
- DOI
10.3390/vaccines10060978