Rachel Kruer, BCCCP, PharmD
Clinical Pharmacy Specialist, Critical Care
Indiana University Health
Disclosure information not submitted.
Mya Tran, PharmD
Clinical Pharmacist
Indiana University Health Methodist Hospital
Indianapolis, Indiana, United States
Disclosure information not submitted.
Abby Pollander, PharmD, BCCCP
Clinical Pharmacy Specialist
Indiana University Health Methodist Hospital
Indianapolis, Indiana, United States
Disclosure information not submitted.
William Fadel, PhD
Clinical Assistant Professor
Department of Biostatistics and Health Data Science Indiana University, Richard M. Fairbanks School of Public Health and School of Medicine
Indianapolis, Indiana, United States
Disclosure information not submitted.
Armisha Desai, PharmD, BCIDP
Clinical Pharmacy Specialist, Infectious Disease
Indiana University Health Methodist Hospital
Indianapolis, Indiana, United States
Disclosure information not submitted.
Title: Mortality Among Critically Ill Patients With COVID-19 Who Received Tocilizumab
Introduction: Cytokine release storm (CRS), characterized by high levels of pro-inflammatory cytokines including interleukin 6 (IL-6), is common in severe acute respiratory syndrome caused by COVID-19. Elevated IL-6 levels may correlate with poor outcomes in COVID-19 patients. Observational studies of tocilizumab, an FDA-approved IL-6 receptor antagonist for CRS, have shown favorable responses in these patients, however, data on the benefit of tocilizumab is inconsistent. This study aims to explore if there is a mortality benefit of tocilizumab in critically ill patients with COVID-19.
Methods: This was a retrospective evaluation of adult patients with severe COVID-19 admitted to the intensive care unit (ICU) at Indiana University Health system from 03/01/2020 to 07/31/2020. Patients were matched in a 1:2 ratio of tocilizumab treated to untreated patients based on baseline characteristics (treatment phase, oxygen requirement, SOFA score). The primary outcome was 28-day mortality from ICU admission. Secondary outcomes included percentage of patients developing bacterial infection during the 28 days following ICU admission, inpatient mortality, 14-day mortality, and discharge status at day 28 from ICU admission.
Results: A total of 144 patients were included. The median age was 63 (IQR 50-71) years, and 89 (62%) were male. At day 28 from ICU admission, 18 (37.5%) patients in the tocilizumab group had died and 20 (20.8%) in the control group (p=0.035). More patients in the control group were discharged (65.6% vs 33.3%, p=0.001). Inpatient mortality occurred in 21 (43.8%) and 21 (21.9%) patients in the tocilizumab and control group respectively (p=0.007). Within the 28 days following ICU admission, 5 (10.4%) patients from the tocilizumab group and 1 (1.0%) patients from the control group had bacteremia (p=0.008).
Conclusions: Tocilizumab was associated with higher mortality and higher rate of bacteremia in critically ill patients.