Clinical characteristics and predictors of survival in adults with coronavirus disease 2019 receiving tocilizumab. Issue 114 (November 2020)

• Record Type: Journal Article
• Authors: Morrison, Austin R.; Johnson, Joseph M.; Griebe, Kristin M.; Jones, Mathew C.; Stine, John J.; Hencken, Laura N.; To, Long; Bianchini, Monica L.; Vahia, Amit T.; Swiderek, Jennifer; Ramesh, Mayur S.; Peters, Michael A.; Smith, Zachary R.
• Is Part Of: Journal of autoimmunity. Issue 114(2020)
• Publication Date: 2020-11
• Subjects: COVID-19 -- Severe acute respiratory syndrome coronavirus 2 -- Cytokine release syndrome -- Interleukin-6 -- Tocilizumab -- Critical illness; Autoimmunity -- Periodicals; Autoimmune diseases -- Periodicals; Autoantibodies -- Periodicals; Autoimmune Diseases -- Periodicals; Auto-immunité -- Périodiques; Maladies auto-immunes -- Périodiques; Electronic journals; 616.978005
• DOI: 10.1016/j.jaut.2020.102512
• Languages: English
• ISSNs: 0896-8411

Abstract

Abstract: Coronavirus disease 2019 (COVID-19) can progress to cytokine storm that is associated with organ dysfunction and death. The purpose of the present study is to determine clinical characteristics associated with 28 day in-hospital survival in patients with coronavirus disease 2019 (COVID-19) that received tocilizumab. This was a retrospective observational cohort study conducted at a five hospital health system in Michigan, United States. Adult patients with confirmed COVID-19 that were admitted to the hospital and received tocilizumab for cytokine storm from March 1, 2020 through April 3, 2020 were included. Patients were grouped into survivors and non-survivors based on 28 day in-hospital mortality. Study day 0 was defined as the day tocilizumab was administered. Factors independently associated with in-hospital survival at 28 days after tocilizumab administration were assessed. Epidemiologic, demographic, laboratory, prognostic scores, treatment, and outcome data were collected and analyzed. Clinical response was collected and defined as a decline of two levels on a six-point ordinal scale of clinical status or discharged alive from the hospital. Of the 81 patients included, the median age was 64 (58–71) years and 56 (69.1%) were male. The 28 day in-hospital mortality was 43.2%. There were 46 (56.8%) patients in the survivors and 35 (43.2%) in the non-survivors group. On study day 0 no differences were noted in demographics, clinical characteristics, severity of illness scores, or treatments received between survivors and non-survivors. C-reactive protein was significantly higher in the non-survivors compared to survivors. Compared to non-survivors, recipients of tocilizumab within 12 days of symptom onset was independently associated with survival (adjusted OR: 0.296, 95% CI: 0.098–0.889). SOFA score ≥8 on day 0 was independently associated with mortality (adjusted OR: 2.842, 95% CI: 1.042–7.753). Clinical response occurred more commonly in survivors than non-survivors (80.4% vs. 5.7%; p < 0.001). Improvements in the six-point ordinal scale and SOFA score were observed in survivors after tocilizumab. Early receipt of tocilizumab in patients with severe COVID-19 was an independent predictor for in-hospital survival at 28 days. Highlights: Patients receiving tocilizumab within 12 days of COVID-19 symptom onset had an increase in 28 day in-hospital survival. A higher severity of illness prior to tocilizumab administration was associated with increased mortality. Secondary infections occurred in 22.2% receiving tocilizumab, but infection was not associated with increased mortality.