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Effects of cytokine blocking agents on hospital mortality in patients admitted to ICU with acute respiratory distress syndrome by SARS-CoV-2 infection: retrospective cohort study.
Multidiscip Respir Med. 2021 Jan 15; 16(1):737.MR

Abstract

Background

The use of cytokine-blocking agents has been proposed to modulate the inflammatory response in patients with COVID-19. Tocilizumab and anakinra were included in the local protocol as an optional treatment in critically ill patients with acute respiratory distress syndrome (ARDS) by SARS-CoV-2 infection. This cohort study evaluated the effects of therapy with cytokine blocking agents on in-hospital mortality in COVID-19 patients requiring mechanical ventilation and admitted to intensive care unit.

Methods

The association between therapy with tocilizumab or anakinra and in-hospital mortality was assessed in consecutive adult COVID-19 patients admitted to our ICU with moderate to severe ARDS. The association was evaluated by comparing patients who received to those who did not receive tocilizumab or anakinra and by using different multivariable Cox models adjusted for variables related to poor outcome, for the propensity to be treated with tocilizumab or anakinra and after patient matching.

Results

Sixty-six patients who received immunotherapy (49 tocilizumab, 17 anakinra) and 28 patients who did not receive immunotherapy were included. The in-hospital crude mortality was 30,3% in treated patients and 50% in nontreated (OR 0.77, 95% CI 0.56-1.05, p=0.069). The adjusted Cox model showed an association between therapy with immunotherapy and in-hospital mortality (HR 0.40, 95% CI 0.19-0.83, p=0.015). This protective effect was further confirmed in the analysis adjusted for propensity score, in the propensity-matched cohort and in the cohort of patients with invasive mechanical ventilation within 2 hours after ICU admission.

Conclusions

Although important limitations, our study showed that cytokine-blocking agents seem to be safe and to improve survival in COVID-19 patients admitted to ICU with ARDS and the need for mechanical ventilation.

Authors+Show Affiliations

Intensive Care Unit, University Hospital of Modena.Intensive Care Unit, University Hospital of Modena.Intensive Care Unit, University Hospital of Modena.Intensive Care Unit, University Hospital of Modena.Intensive Care Unit, University Hospital of Modena.Intensive Care Unit, University Hospital of Modena.Intensive Care Unit, University Hospital of Modena.Intensive Care Unit, University Hospital of Modena.Respiratory Disease Unit, University Hospital of Modena.Respiratory Disease Unit, University Hospital of Modena.Respiratory Disease Unit, University Hospital of Modena.Infectious Disease Unit, University Hospital of Modena.Infectious Disease Unit, University Hospital of Modena.Infectious Disease Unit, University Hospital of Modena.Immunology Laboratory, University of Modena and Reggio Emilia.Nephrology Dialysis and Transplant Unit, University Hospital of Modena, Italy.Intensive Care Unit, University Hospital of Modena. Respiratory Disease Unit, University Hospital of Modena. Infectious Disease Unit, University Hospital of Modena. Immunology Laboratory, University of Modena and Reggio Emilia. Nephrology Dialysis and Transplant Unit, University Hospital of Modena, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34040779

Citation

Coloretti, Irene, et al. "Effects of Cytokine Blocking Agents On Hospital Mortality in Patients Admitted to ICU With Acute Respiratory Distress Syndrome By SARS-CoV-2 Infection: Retrospective Cohort Study." Multidisciplinary Respiratory Medicine, vol. 16, no. 1, 2021, p. 737.
Coloretti I, Busani S, Biagioni E, et al. Effects of cytokine blocking agents on hospital mortality in patients admitted to ICU with acute respiratory distress syndrome by SARS-CoV-2 infection: retrospective cohort study. Multidiscip Respir Med. 2021;16(1):737.
Coloretti, I., Busani, S., Biagioni, E., Venturelli, S., Munari, E., Sita, M., DallAra, L., Tosi, M., Clini, E., Tonelli, R., Fantini, R., Mussini, C., Meschiari, M., Guaraldi, G., Cossarizza, A., Alfano, G., & Girardis, M. (2021). Effects of cytokine blocking agents on hospital mortality in patients admitted to ICU with acute respiratory distress syndrome by SARS-CoV-2 infection: retrospective cohort study. Multidisciplinary Respiratory Medicine, 16(1), 737. https://doi.org/10.4081/mrm.2021.737
Coloretti I, et al. Effects of Cytokine Blocking Agents On Hospital Mortality in Patients Admitted to ICU With Acute Respiratory Distress Syndrome By SARS-CoV-2 Infection: Retrospective Cohort Study. Multidiscip Respir Med. 2021 Jan 15;16(1):737. PubMed PMID: 34040779.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of cytokine blocking agents on hospital mortality in patients admitted to ICU with acute respiratory distress syndrome by SARS-CoV-2 infection: retrospective cohort study. AU - Coloretti,Irene, AU - Busani,Stefano, AU - Biagioni,Emanuela, AU - Venturelli,Sophie, AU - Munari,Elena, AU - Sita,Marco, AU - DallAra,Lorenzo, AU - Tosi,Martina, AU - Clini,Enrico, AU - Tonelli,Roberto, AU - Fantini,Riccardo, AU - Mussini,Cristina, AU - Meschiari,Marianna, AU - Guaraldi,Giovanni, AU - Cossarizza,Andrea, AU - Alfano,Gaetano, AU - Girardis,Massimo, Y1 - 2021/05/17/ PY - 2020/11/22/received PY - 2021/02/19/accepted PY - 2021/5/27/entrez PY - 2021/5/28/pubmed PY - 2021/5/28/medline KW - COVID-19 KW - acute respiratory distress syndrome KW - anakinra KW - intensive care unit KW - mechanical ventilation KW - tocilizumab SP - 737 EP - 737 JF - Multidisciplinary respiratory medicine JO - Multidiscip Respir Med VL - 16 IS - 1 N2 - Background: The use of cytokine-blocking agents has been proposed to modulate the inflammatory response in patients with COVID-19. Tocilizumab and anakinra were included in the local protocol as an optional treatment in critically ill patients with acute respiratory distress syndrome (ARDS) by SARS-CoV-2 infection. This cohort study evaluated the effects of therapy with cytokine blocking agents on in-hospital mortality in COVID-19 patients requiring mechanical ventilation and admitted to intensive care unit. Methods: The association between therapy with tocilizumab or anakinra and in-hospital mortality was assessed in consecutive adult COVID-19 patients admitted to our ICU with moderate to severe ARDS. The association was evaluated by comparing patients who received to those who did not receive tocilizumab or anakinra and by using different multivariable Cox models adjusted for variables related to poor outcome, for the propensity to be treated with tocilizumab or anakinra and after patient matching. Results: Sixty-six patients who received immunotherapy (49 tocilizumab, 17 anakinra) and 28 patients who did not receive immunotherapy were included. The in-hospital crude mortality was 30,3% in treated patients and 50% in nontreated (OR 0.77, 95% CI 0.56-1.05, p=0.069). The adjusted Cox model showed an association between therapy with immunotherapy and in-hospital mortality (HR 0.40, 95% CI 0.19-0.83, p=0.015). This protective effect was further confirmed in the analysis adjusted for propensity score, in the propensity-matched cohort and in the cohort of patients with invasive mechanical ventilation within 2 hours after ICU admission. Conclusions: Although important limitations, our study showed that cytokine-blocking agents seem to be safe and to improve survival in COVID-19 patients admitted to ICU with ARDS and the need for mechanical ventilation. SN - 1828-695X UR - https://www.unboundmedicine.com/medline/citation/34040779/Effects_of_cytokine_blocking_agents_on_hospital_mortality_in_patients_admitted_to_ICU_with_acute_respiratory_distress_syndrome_by_SARS_CoV_2_infection:_retrospective_cohort_study_ L2 - https://doi.org/10.4081/mrm.2021.737 DB - PRIME DP - Unbound Medicine ER -
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