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Clinical characteristics and predictors of survival in adults with coronavirus disease 2019 receiving tocilizumab.
J Autoimmun. 2020 11; 114:102512.JA

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.

Authors+Show Affiliations

Department of Pharmacy, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA.Department of Pharmacy, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA.Department of Pharmacy, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA.Department of Pharmacy, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA.Department of Pharmacy, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA.Department of Pharmacy, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA.Department of Pharmacy, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA.Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA.Division of Infectious Diseases, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA.Division of Pulmonary & Critical Care Medicine, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA.Division of Infectious Diseases, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA.Department of Pharmacy, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA.Department of Pharmacy, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA. Electronic address: zsmith1@hfhs.org.

Pub Type(s)

Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

32646770

Citation

Morrison, Austin R., et al. "Clinical Characteristics and Predictors of Survival in Adults With Coronavirus Disease 2019 Receiving Tocilizumab." Journal of Autoimmunity, vol. 114, 2020, p. 102512.
Morrison AR, Johnson JM, Griebe KM, et al. Clinical characteristics and predictors of survival in adults with coronavirus disease 2019 receiving tocilizumab. J Autoimmun. 2020;114:102512.
Morrison, A. R., Johnson, J. M., Griebe, K. M., Jones, M. C., Stine, J. J., Hencken, L. N., To, L., Bianchini, M. L., Vahia, A. T., Swiderek, J., Ramesh, M. S., Peters, M. A., & Smith, Z. R. (2020). Clinical characteristics and predictors of survival in adults with coronavirus disease 2019 receiving tocilizumab. Journal of Autoimmunity, 114, 102512. https://doi.org/10.1016/j.jaut.2020.102512
Morrison AR, et al. Clinical Characteristics and Predictors of Survival in Adults With Coronavirus Disease 2019 Receiving Tocilizumab. J Autoimmun. 2020;114:102512. PubMed PMID: 32646770.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical characteristics and predictors of survival in adults with coronavirus disease 2019 receiving tocilizumab. AU - Morrison,Austin R, AU - Johnson,Joseph M, AU - Griebe,Kristin M, AU - Jones,Mathew C, AU - Stine,John J, AU - Hencken,Laura N, AU - To,Long, AU - Bianchini,Monica L, AU - Vahia,Amit T, AU - Swiderek,Jennifer, AU - Ramesh,Mayur S, AU - Peters,Michael A, AU - Smith,Zachary R, Y1 - 2020/07/03/ PY - 2020/06/03/received PY - 2020/06/23/revised PY - 2020/06/24/accepted PY - 2020/7/11/pubmed PY - 2020/10/28/medline PY - 2020/7/11/entrez KW - COVID-19 KW - Critical illness KW - Cytokine release syndrome KW - Interleukin-6 KW - Severe acute respiratory syndrome coronavirus 2 KW - Tocilizumab SP - 102512 EP - 102512 JF - Journal of autoimmunity JO - J Autoimmun VL - 114 N2 - 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. SN - 1095-9157 UR - https://www.unboundmedicine.com/medline/citation/32646770/Clinical_characteristics_and_predictors_of_survival_in_adults_with_coronavirus_disease_2019_receiving_tocilizumab_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0896-8411(20)30134-7 DB - PRIME DP - Unbound Medicine ER -