Predictive factors of mortality in patients treated with tocilizumab for acute respiratory distress syndrome related to coronavirus disease 2019 (COVID-19)

Microbes Infect. 2020 Oct;22(9):500-503. doi: 10.1016/j.micinf.2020.06.005. Epub 2020 Jun 20.

Abstract

COVID-19 patients (n = 34) suffering from ARDS were treated with tocilizumab (TCZ). Outcome was classified in two groups: "Death" and "Recovery". Predictive factors of mortality were studied. Mean age was 75.3, mean oxygen (O2) requirements 10.4 l/min. At baseline, all patients had multiple biological abnormalities (lymphopenia, increased CRP, ferritin, fibrinogen, D-dimer and liver enzymes). 24 patients (70.5%) recovered after TCZ therapy and 10 died (29.5%). Deceased subjects differed from patients in whom treatment was effective with regard to more pronounced lymphopenia (0.6 vs 1.0 G/l; p = 0.037), lower platelet number (156 vs 314 G/l; p = 0.0001), lower fibrinogen serum level (0.6 vs 1.0 G/l; p = 0.03), higher aspartate-amino-transferase (108 vs 57 UI/l; p = 0.05) and greater O2 requirements (11 vs 8 l/min; p = 0.003).

Keywords: Acute respiratory distress syndrome; Biomarkers; COVID-19; Predictive factors; SARS-CoV-2; Tocilizumab.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Anticoagulants / therapeutic use
  • Aspartate Aminotransferases / blood
  • Betacoronavirus / drug effects
  • Betacoronavirus / pathogenicity*
  • Biomarkers / blood
  • C-Reactive Protein / metabolism
  • COVID-19
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / drug therapy*
  • Coronavirus Infections / mortality
  • Coronavirus Infections / virology
  • Female
  • Fibrin Fibrinogen Degradation Products / metabolism
  • Fibrinogen / metabolism
  • Humans
  • Hydroxychloroquine / therapeutic use
  • Lymphopenia / diagnosis
  • Lymphopenia / drug therapy*
  • Lymphopenia / mortality
  • Lymphopenia / virology
  • Male
  • Pandemics
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / drug therapy*
  • Pneumonia, Viral / mortality
  • Pneumonia, Viral / virology
  • Prognosis
  • Respiratory Distress Syndrome / diagnosis
  • Respiratory Distress Syndrome / drug therapy*
  • Respiratory Distress Syndrome / mortality
  • Respiratory Distress Syndrome / virology
  • Retrospective Studies
  • SARS-CoV-2
  • Survival Analysis
  • Thrombocytopenia / diagnosis
  • Thrombocytopenia / drug therapy*
  • Thrombocytopenia / mortality
  • Thrombocytopenia / virology
  • Tomography, X-Ray Computed
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Antibodies, Monoclonal, Humanized
  • Anticoagulants
  • Biomarkers
  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D
  • Hydroxychloroquine
  • Fibrinogen
  • C-Reactive Protein
  • Aspartate Aminotransferases
  • tocilizumab