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Effect of Tocilizumab on “Ventilator Free Days” Composite Outcome in SARS-CoV-2 Patients: A Retrospective Competing Risk Analysis

Effect of Tocilizumab on “Ventilator Free Days” Composite Outcome in SARS-CoV-2 Patients: A... AbstractBackgroundSARS-CoV-2 infection demonstrates a wide range of severity. More severe cases demonstrate a cytokine storm with elevated serum interleukin-6, hence IL-6 receptor antibody tocilizumab was tried for the management of severe cases.AimsEffect of tocilizumab on ventilator-free days among critically ill SARS-CoV-2 patients.MethodRetrospective propensity score matching study, comparing mechanically ventilated patients who received tocilizumab to a control group.Results29 patients in the intervention group were compared to 29 controls. Matched groups were similar. Ventilator-free days were more numerous in the intervention group (SHR 2.7, 95% CI: 1.2 – 6.3; p = 0.02), ICU mortality rate was not different (37.9% versus 62%, p = 0.1), actual ventilator-free periods were significantly longer in tocilizumab group (mean difference 4.7 days; p = 0.02). Sensitivity analysis showed a significantly lower hazard ratio of death in tocilizumab group (HR 0.49, 95% CI: 0.25 – 0.97; p = 0.04). There was no difference in positive cultures among groups (55.2% in tocilizumab group versus 34.5% in the control; p = 0.1).ConclusionTocilizumab may improve the composite outcome of ventilator-free days at day 28 among mechanically ventilated SARS-CoV-2 patients; it is associated with significantly longer actual ventilator-free periods, and insignificantly lower mortality and higher superinfection. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Romanian Journal of Anaesthesia and Intensive Care de Gruyter

Effect of Tocilizumab on “Ventilator Free Days” Composite Outcome in SARS-CoV-2 Patients: A Retrospective Competing Risk Analysis

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Publisher
de Gruyter
Copyright
© 2022 Ahmed F. Mady et al., published by Sciendo
eISSN
2502-0307
DOI
10.2478/rjaic-2022-0001
Publisher site
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Abstract

AbstractBackgroundSARS-CoV-2 infection demonstrates a wide range of severity. More severe cases demonstrate a cytokine storm with elevated serum interleukin-6, hence IL-6 receptor antibody tocilizumab was tried for the management of severe cases.AimsEffect of tocilizumab on ventilator-free days among critically ill SARS-CoV-2 patients.MethodRetrospective propensity score matching study, comparing mechanically ventilated patients who received tocilizumab to a control group.Results29 patients in the intervention group were compared to 29 controls. Matched groups were similar. Ventilator-free days were more numerous in the intervention group (SHR 2.7, 95% CI: 1.2 – 6.3; p = 0.02), ICU mortality rate was not different (37.9% versus 62%, p = 0.1), actual ventilator-free periods were significantly longer in tocilizumab group (mean difference 4.7 days; p = 0.02). Sensitivity analysis showed a significantly lower hazard ratio of death in tocilizumab group (HR 0.49, 95% CI: 0.25 – 0.97; p = 0.04). There was no difference in positive cultures among groups (55.2% in tocilizumab group versus 34.5% in the control; p = 0.1).ConclusionTocilizumab may improve the composite outcome of ventilator-free days at day 28 among mechanically ventilated SARS-CoV-2 patients; it is associated with significantly longer actual ventilator-free periods, and insignificantly lower mortality and higher superinfection.

Journal

Romanian Journal of Anaesthesia and Intensive Care – de Gruyter

Published: Jul 1, 2022

Keywords: SARS-CoV-2; tocilizumab; ventilator-free days

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