OBJECTIVES: To identify predictors of clinical improvement and intubation/death in tocilizumab-treated severe COVID19, focusing on IL6 and CRP longitudinal monitoring. METHODS: 173 consecutive patients with severe COVID-19 pneumonia receiving tocilizumab in Reggio Emilia province Hospitals between 11 March and 3 June 2020 were enrolled in a prospective cohort study. Clinical improvement was defined as status improvement on a six-category ordinal scale or discharge from the hospital, whichever came first. A composite outcome of intubation/death was also evaluated. CRP and IL-6 levels were determined before TCZ administration (T0) and after 3 (T3), and 7 (T7) days. RESULTS: At multivariate analysis T0 and T3 CRP levels were negatively associated with clinical improvement (OR 0.13, CI 0.03–0.55 and OR 0.11, CI 0.0–0.46) (p=0.006 and p=0.003) and positively associated with intubation/death (OR 17.66, CI 2.47–126.14 and OR 5.34, CI: 1.49–19.12) (p=0.01 and p=0.004). No significant associations with IL-6 values were observed. General linear model analyses for repeated measures showed significantly different trends for CRP from day 3 to day 7 between patients who improved and those who did not, and between patients who were intubated or died and those who were not (p<0.0001 for both). ROC analysis identified a baseline CRP level of 15.8 mg/dl as the best cut-off to predict intubation/death (AUC = 0.711, sensitivity = 0.67, specificity = 0.71). CONCLUSIONS: CRP serial measurements in the first week of TCZ therapy are useful in identifying patients developing poor outcomes.

Acute-phase reactants during tocilizumab therapy for severe COVID-19 pneumonia / Cassone, G; Dolci, G; Besutti, G; Muratore, F; Bajocchi, G; Mancuso, P; Catanoso, M; Spaggiari, L; Galli, E; Palermo, A; Pipitone, N; Croci, S; Massari, M; Facciolongo, N; Menzella, F; Negri, Ea; Zerbini, A; Belloni, L; Cimino, L; Teopompi, E; Sampaolesi, F; Salsi, P; Costantini, M; Giorgi Rossi, P; Aldigeri, R; Salvarani, C.. - In: CLINICAL AND EXPERIMENTAL RHEUMATOLOGY. - ISSN 1593-098X. - 38:6(2020), pp. 1215-1222.

Acute-phase reactants during tocilizumab therapy for severe COVID-19 pneumonia

Aldigeri R;
2020

Abstract

OBJECTIVES: To identify predictors of clinical improvement and intubation/death in tocilizumab-treated severe COVID19, focusing on IL6 and CRP longitudinal monitoring. METHODS: 173 consecutive patients with severe COVID-19 pneumonia receiving tocilizumab in Reggio Emilia province Hospitals between 11 March and 3 June 2020 were enrolled in a prospective cohort study. Clinical improvement was defined as status improvement on a six-category ordinal scale or discharge from the hospital, whichever came first. A composite outcome of intubation/death was also evaluated. CRP and IL-6 levels were determined before TCZ administration (T0) and after 3 (T3), and 7 (T7) days. RESULTS: At multivariate analysis T0 and T3 CRP levels were negatively associated with clinical improvement (OR 0.13, CI 0.03–0.55 and OR 0.11, CI 0.0–0.46) (p=0.006 and p=0.003) and positively associated with intubation/death (OR 17.66, CI 2.47–126.14 and OR 5.34, CI: 1.49–19.12) (p=0.01 and p=0.004). No significant associations with IL-6 values were observed. General linear model analyses for repeated measures showed significantly different trends for CRP from day 3 to day 7 between patients who improved and those who did not, and between patients who were intubated or died and those who were not (p<0.0001 for both). ROC analysis identified a baseline CRP level of 15.8 mg/dl as the best cut-off to predict intubation/death (AUC = 0.711, sensitivity = 0.67, specificity = 0.71). CONCLUSIONS: CRP serial measurements in the first week of TCZ therapy are useful in identifying patients developing poor outcomes.
Acute-phase reactants during tocilizumab therapy for severe COVID-19 pneumonia / Cassone, G; Dolci, G; Besutti, G; Muratore, F; Bajocchi, G; Mancuso, P; Catanoso, M; Spaggiari, L; Galli, E; Palermo, A; Pipitone, N; Croci, S; Massari, M; Facciolongo, N; Menzella, F; Negri, Ea; Zerbini, A; Belloni, L; Cimino, L; Teopompi, E; Sampaolesi, F; Salsi, P; Costantini, M; Giorgi Rossi, P; Aldigeri, R; Salvarani, C.. - In: CLINICAL AND EXPERIMENTAL RHEUMATOLOGY. - ISSN 1593-098X. - 38:6(2020), pp. 1215-1222.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11381/2885247
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