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Profiling COVID-19 pneumonia progressing into the cytokine storm syndrome: Results from a single Italian Centre study on tocilizumab versus standard of care.
J Clin Virol. 2020 08; 129:104444.JC

Abstract

OBJECTIVE

Approximately 5% of patients with coronavirus disease 2019 (COVID-19) develop a life-threatening pneumonia that often occurs in the setting of increased inflammation or "cytokine storm". Anti-cytokine treatments are being evaluated but optimal patient selection remains unclear, and the aim of our study is to address this point.

METHODS

Between February 29 to April 6, 2020, 111 consecutive hospitalized patients with COVID-19 pneumonia were evaluated in a single centre retrospective study. Patients were divided in two groups: 42 severe cases (TOCI) with adverse prognostic features including raised CRP and IL-6 levels, who underwent anti-cytokine treatments, mostly tocilizumab, and 69 standard of care patients (SOC).

RESULTS

In the TOCI group, all received anti-viral therapy and 40% also received glucocorticoids. In TOCI, 62% of cases were ventilated and there were three deaths (17.8 ± 10.6 days, mean follow up) with 7/26 cases remaining on ventilators, without improvement, and 17/26 developed bacterial superinfection. One fatality occurred in the 15 TOCI cases treated on noninvasive ventilation and one serious bacterial superinfection. Of the 69 cases in SOC, there was no fatalities and no bacterial complications. The TOCI group had higher baseline CRP and IL-6 elevations (p < 0.0001 for both) and higher neutrophils and lower lymphocyte levels (p = 0.04 and p = 0.001, respectively) with the TOCI ventilated patients having higher markers than non-ventilated TOCI patients.

CONCLUSION

Higher inflammatory markers, more infections and worse outcomes characterized ventilated TOCI cases compared to ward based TOCI. Despite the confounding factors, this suggests that therapy time in anti-cytokine randomized trials will be key.

Authors+Show Affiliations

Clinic of Rheumatology, Department of Medicine (DAME), ASUFC, University of Udine, Udine, Italy. Electronic address: luca.quartuccio@asufc.sanita.fvg.it.Clinic of Rheumatology, Department of Medicine (DAME), ASUFC, University of Udine, Udine, Italy.National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC), Leeds Teaching Hospitals, Leeds, UK.Institute of Clinical Pathology, ASUFC, Udine, Italy.Infectious Diseases Unit, ASUFC, Udine, Italy.Infectious Diseases Unit, ASUFC, Udine, Italy.Infectious Diseases Unit, ASUFC, Udine, Italy.Department of Anesthesia and Intensive Care, ASUFC, Udine, Italy; Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy.Institute of Clinical Pathology, ASUFC, Udine, Italy.Department of Anesthesia and Intensive Care, ASUFC, Udine, Italy.Clinic of Rheumatology, Department of Medicine (DAME), ASUFC, University of Udine, Udine, Italy.Infectious Diseases Unit, ASUFC, Udine, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32570043

Citation

Quartuccio, Luca, et al. "Profiling COVID-19 Pneumonia Progressing Into the Cytokine Storm Syndrome: Results From a Single Italian Centre Study On Tocilizumab Versus Standard of Care." Journal of Clinical Virology : the Official Publication of the Pan American Society for Clinical Virology, vol. 129, 2020, p. 104444.
Quartuccio L, Sonaglia A, McGonagle D, et al. Profiling COVID-19 pneumonia progressing into the cytokine storm syndrome: Results from a single Italian Centre study on tocilizumab versus standard of care. J Clin Virol. 2020;129:104444.
Quartuccio, L., Sonaglia, A., McGonagle, D., Fabris, M., Peghin, M., Pecori, D., De Monte, A., Bove, T., Curcio, F., Bassi, F., De Vita, S., & Tascini, C. (2020). Profiling COVID-19 pneumonia progressing into the cytokine storm syndrome: Results from a single Italian Centre study on tocilizumab versus standard of care. Journal of Clinical Virology : the Official Publication of the Pan American Society for Clinical Virology, 129, 104444. https://doi.org/10.1016/j.jcv.2020.104444
Quartuccio L, et al. Profiling COVID-19 Pneumonia Progressing Into the Cytokine Storm Syndrome: Results From a Single Italian Centre Study On Tocilizumab Versus Standard of Care. J Clin Virol. 2020;129:104444. PubMed PMID: 32570043.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Profiling COVID-19 pneumonia progressing into the cytokine storm syndrome: Results from a single Italian Centre study on tocilizumab versus standard of care. AU - Quartuccio,Luca, AU - Sonaglia,Arianna, AU - McGonagle,Dennis, AU - Fabris,Martina, AU - Peghin,Maddalena, AU - Pecori,Davide, AU - De Monte,Amato, AU - Bove,Tiziana, AU - Curcio,Francesco, AU - Bassi,Flavio, AU - De Vita,Salvatore, AU - Tascini,Carlo, Y1 - 2020/05/15/ PY - 2020/05/06/received PY - 2020/05/13/accepted PY - 2020/6/23/pubmed PY - 2020/8/12/medline PY - 2020/6/23/entrez KW - COVID-19 KW - Coronavirus KW - Cytokine KW - Intensive care KW - Tocilizumab SP - 104444 EP - 104444 JF - Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology JO - J. Clin. Virol. VL - 129 N2 - OBJECTIVE: Approximately 5% of patients with coronavirus disease 2019 (COVID-19) develop a life-threatening pneumonia that often occurs in the setting of increased inflammation or "cytokine storm". Anti-cytokine treatments are being evaluated but optimal patient selection remains unclear, and the aim of our study is to address this point. METHODS: Between February 29 to April 6, 2020, 111 consecutive hospitalized patients with COVID-19 pneumonia were evaluated in a single centre retrospective study. Patients were divided in two groups: 42 severe cases (TOCI) with adverse prognostic features including raised CRP and IL-6 levels, who underwent anti-cytokine treatments, mostly tocilizumab, and 69 standard of care patients (SOC). RESULTS: In the TOCI group, all received anti-viral therapy and 40% also received glucocorticoids. In TOCI, 62% of cases were ventilated and there were three deaths (17.8 ± 10.6 days, mean follow up) with 7/26 cases remaining on ventilators, without improvement, and 17/26 developed bacterial superinfection. One fatality occurred in the 15 TOCI cases treated on noninvasive ventilation and one serious bacterial superinfection. Of the 69 cases in SOC, there was no fatalities and no bacterial complications. The TOCI group had higher baseline CRP and IL-6 elevations (p < 0.0001 for both) and higher neutrophils and lower lymphocyte levels (p = 0.04 and p = 0.001, respectively) with the TOCI ventilated patients having higher markers than non-ventilated TOCI patients. CONCLUSION: Higher inflammatory markers, more infections and worse outcomes characterized ventilated TOCI cases compared to ward based TOCI. Despite the confounding factors, this suggests that therapy time in anti-cytokine randomized trials will be key. SN - 1873-5967 UR - https://www.unboundmedicine.com/medline/citation/32570043/Profiling_COVID_19_pneumonia_progressing_into_the_cytokine_storm_syndrome:_Results_from_a_single_Italian_Centre_study_on_tocilizumab_versus_standard_of_care_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1386-6532(20)30186-4 DB - PRIME DP - Unbound Medicine ER -