Alex Adams, MD
Resident - Internal medicine
Northeast Georgia Health System, Gainesville, GA, Georgia, United States
Disclosure information not submitted.
David Jefferies, APNP
APNP
Northeast Georgia Health System, Gainesville, GA, United States
Disclosure information not submitted.
.jpg "Martin Herrera, MD photo")
Martin Herrera, MD
Resident
Northeast Georgia Health System, Gainesville, GA
Gainesville, Georgia, United States
Disclosure information not submitted.
Ankit Sakhuja, MBBS, FACP, FASN, FCCP
Assistant Professor Of Medicine
WVU Medicine, J.W. Ruby Memorial Hospital, United States
Disclosure information not submitted.
Achuta Guddati, MD, PhD
Associate Professor
Augusta University, Augusta, GA 30909., United States
Disclosure information not submitted.
Rahul Nanchal, MD, MS, FCCM
Physician
Medical College of Wisconsin
Delafied, Wisconsin, United States
Disclosure information not submitted.
Gagan Kumar, MD, MA, MS
Northeast Georgia Medical Center
Gainesville, Georgia
Disclosure information not submitted.
Title: Tocilizumab in COVID-19 patients requiring invasive mechanical ventilation – who benefits most?
Introduction
In severe Covid 19 infection, cytokine storm possibly plays a role in development of worsening of symptoms and possibly worse outcomes. Tocilizumab has been used in patients with Covid-19 on invasive mechanical ventilation (IMV) with improved outcomes. However, which group of patients benefit from this medication is unclear.
Methods
We identified primary admissions of all adult COVID19 patients on invasive mechanical ventilation (IMV) in EMR with positive COVID19 test results. Those who died or were extubated within 48 hours were excluded. Primary outcomes included in hospital mortality. We constructed propensity matched multivariable Cox regression model with bootstrapping (2000 replicates and case resampling with replacement ) to examine the association of tocilizumab with in-hospital mortality. We examined various subgroup to see if tocilizumab was more effective in certain groups. Subgroups studied were age ≥ 65 years, gender, Hispanic race, inflammatory markers, various comorbidities and 4C score.
Results
There were 483 patients meeting study criteria. Of these 147(30.4%) received tocilizumab. Patients who received tocilizumab were sicker and had lower PF ratio, higher use of paralytics and higher inflammatory markers when compared to those who did not. In hospital mortality was not significantly different (tocilizumab: 59.9% vs No tocilizumab: 64.3%, p=0.35). On adjusted analysis, mortality was lower in tocilizumab group with hazard ratio of 0.67 (95%CI 0.50-0.91, p = 0.011). On Subgroup analysis, tocilizumab was associated with lower mortality in age ≥ 65 years, females, and Hispanics, diabetics and more severe COVID19 with 4C score of ≥16.
Conclusions
Tocilizumab was associated with improved outcomes in COVID19 patients on IMV without increasing risk of hospital acquired infection. Patients with higher 4C score, female gender, elderly, diabetics and Hispanics responded better to tocilizumab.