scholarly journals Comparative Survival Analysis of Immunomodulatory Therapy for COVID-19 ‘Cytokine Storm’: A Retrospective Observational Cohort Study

2020 ◽  
Author(s):  
Sonali Narain ◽  
Dimitre G. Stefanov ◽  
Alice S. Chau ◽  
Andrew G. Weber ◽  
Galina Marder ◽  
...  
Keyword(s):  
Lactate Dehydrogenase ◽  
Hospital Mortality ◽  
Standard Of Care ◽  
P Value ◽  
Cytokine Storm ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Treatment Standard ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study

AbstractBackgroundCytokine storm is a marker of COVID-19 illness severity and increased mortality. Immunomodulatory treatments have been repurposed to improve mortality outcomes.MethodsWe conducted a retrospective analysis of electronic health records across the Northwell Health system. COVID-19 patients hospitalized between March 1, 2020 and April 15, 2020, were included. Cytokine storm was defined by inflammatory markers: ferritin >700ng/mL, C-reactive protein >30mg/dL, or lactate dehydrogenase >300U/L. Patients were subdivided into six groups -no immunomodulatory treatment (standard of care) and five groups that received either corticosteroids, anti-interleukin 6 (IL-6) antibody (tocilizumab) or anti-IL-1 therapy (anakinra) alone or in combination with corticosteroids. The primary outcome was hospital mortality.ResultsThere were 3,098 patients who met inclusion criteria. The most common comorbidities were hypertension (40-56%), diabetes (32-43%) and cardiovascular disease (2-15%). Patients most frequently met criteria with high lactate dehydrogenase (74.8%) alone, or in combination, followed by ferritin (71.4%) and C-reactive protein (9.4%). More than 80% of patients had an elevated D-dimer. Patients treated with a combination of tocilizumab and corticosteroids (Hazard Ratio [HR]: 0.459, 95% Confidence Interval [CI]: 0.295-0.714; p<0.0001) or corticosteroids alone (HR: 0.696, 95% CI: 0.512-0.946; p=0.01) had improved hospital survival compared to standard of care. Corticosteroids and tocilizumab was associated with increased survival when compared to corticosteroids and anakinra (HR: 0.612, 95% CI: 0.391-0.958; p-value=0.02).ConclusionsWhen compared to standard of care, corticosteroid and tocilizumab used in combination, or corticosteroids alone, was associated with reduced hospital mortality for patients with COVID-19 cytokine storm.

Experience of using heliox in the treatment of viral pneumonia in COVID-19

MedAlliance ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 8-14
Keyword(s):  
Lactate Dehydrogenase ◽  
Viral Pneumonia ◽  
P Value ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Number Of Patients ◽  
Helium Mixture ◽  
Ct Data ◽  
Group 2 ◽  
Group 1

SummaryIntroduction. With the ongoing COVID-19 pandemic, finding new treatments is an extremely important issue. The effectiveness of heliox was previously demonstrated in the complex treatment of patients with various bron-chopulmonary pathologies. Therefore, this method has been recommended for the treatment of pneumonia associated with COVID-19. Purpose. To study the safety and efficacy of inhaled heliox therapy in the treatment of pneumonia in COVID-19. Materials and methods. A sing-le-center prospective study was carried out for the period from 01.12.2020 to 15.02.2021. The study included 91 pa-tients. The patients were divided into two groups: group 1 (using heliox) included 46 people, and group 2 (con-trol) — 45. Inhalations of a heated oxygen-helium mixture heliox (70% helium, 30% oxygen) were carried out using “Ingalit-B2-01” inhaler. Objective (saturation, O2 flow) and laboratory parameters (lactate dehydrogenase, C-reactive protein), as well as chest organs CT data were studied. Differences between groups were determined using the χ2 test, as well as the Mann–Whitney U-test. The p value <0.05 was considered significant. Results. In group 1, side effects developed in 5 (11.3%) patients. These patients refused to further participate in the study. Final number of patients in group 1 — 41. Among patients of group 1, there was a tendency towards a more rapid normalization of lactate dehydrogenase and C-reactive protein, as well as a decrease in oxygen dependence. In group 1, according to CT data, no progression of pneumonia was recorded. In group 2, progression was observed in 6 (13.3%) patients. The overall effectiveness of treatment among patients in group 1 was 100%, among patients in group 2 — 86.7%. The differences between the groups are statistically sig-nificant (p=0.02). Conclusion. The use of inhalations with a heated oxygen-helium mixture heliox (30% oxygen, 70% helium) has shown its effectiveness and safety in the treatment of viral pneumonia (CT1- 2) associated with COVID-19.

scholarly journals Tocilizumab Treatment Reduces Mortality in Hospitalized Patients with COVID-19

2021 ◽  
Author(s):  
Saliaj ◽  
BCCCP BCPS PharmD Matthew Li ◽  
Rizzo ◽  
Nassar ◽  
Nso ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Conditional Logistic Regression ◽  
Standard Of Care ◽  
Blood Oxygen Saturation ◽  
Early Administration ◽  
Logistic Regression Models ◽  
Risk Of Mortality ◽  
Observational Cohort ◽  
And Gender ◽  
Retrospective Observational Cohort Study

Abstract Aims This study aimed to investigate the potential of tocilizumab therapy in minimizing mortality and mechanical ventilation (MV) requirements among hospitalized COVID-19 patients. Methods A single-center, retrospective, observational cohort study of 375 patients with severe COVID-19 (March 1 and April 22, 2020) included 150 patients treated with Tocilizumab and 225 consecutive control patients adjusted for age and gender. Both groups received concomitant standard of care treatments in addition to Tocilizumab. The statistical methods relied on survival analyses, conditional logistic regression models, and contingency analyses. The primary outcomes included in-hospital mortality and the MV requirement. Results Tocilizumab associated with improved in-hospital mortality (34.7% vs 46.7%, P = 0.0136) and lower requirement for MV on days 1, 3, and 5 after treatment (P = 0.005, P < 0.0001, and P = 0.0021, respectively). Lower mortality was observed if tocilizumab was administered within 48 hours after admission (P = 0.0226). Older age and low blood oxygen saturation on admission decreased the odds of survival (P < 0.005). Conclusion Our study demonstrates a significant reduction in mortality and decreased requirement of MV with tocilizumab treatment in addition to the standard of care. Early administration of Tocilizumab within 48 hours reduces the risk of mortality.

scholarly journals Biomarkers of cytokine storm as red flags for severe and fatal COVID-19 cases: A living systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253894
Author(s):  
Ana Karla G. Melo ◽  
Keilla M. Milby ◽  
Ana Luiza M. A. Caparroz ◽  
Ana Carolina P. N. Pinto ◽  
Rodolfo R. P. Santos ◽  
...  
Keyword(s):  
Lactate Dehydrogenase ◽  
Interleukin 6 ◽  
Aspartate Aminotransferase ◽  
Laboratory Data ◽  
Cytokine Storm ◽  
Red Flags ◽  
C Reactive Protein ◽  
Laboratory Parameters ◽  
Reactive Protein ◽  
D Dimer

Objective To describe the laboratory parameters and biomarkers of the cytokine storm syndrome associated with severe and fatal COVID-19 cases. Methods A search with standardized descriptors and synonyms was performed on November 28th, 2020 of the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, LILACS, and IBECS to identify studies of interest. Grey literature searches and snowballing techniques were additionally utilized to identify yet-unpublished works and related citations. Two review authors independently screened the retrieved titles and abstracts, selected eligible studies for inclusion, extracted data from the included studies, and then assessed the risk of bias using the Newcastle-Ottawa Scale. Eligible studies were those including laboratory parameters—including serum interleukin-6 levels—from mild, moderate, or severe COVID-19 cases. Laboratory parameters, such as interleukin-6, ferritin, hematology, C-Reactive Protein, procalcitonin, lactate dehydrogenase, aspartate aminotransferase, creatinine, and D-dimer, were extracted from the studies. Meta-analyses were conducted using the laboratory data to estimate mean differences with associated 95% confidence intervals. Data synthesis The database search yielded 9,620 records; 40 studies (containing a total of 9,542 patients) were included in the final analysis. Twenty-one studies (n = 4,313) assessed laboratory data related to severe COVID-19 cases, eighteen studies (n = 4,681) assessed predictors for fatal COVID-19 cases and one study (n = 548) assessed laboratory biomarkers related to severe and fatal COVID-19 cases. Lymphopenia, thrombocytopenia, and elevated levels of interleukin-6, ferritin, D-dimer, aspartate aminotransferase, C-Reactive-Protein, procalcitonin, creatinine, neutrophils and leucocytes were associated with severe and fatal COVID-19 cases. Conclusions This review points to interleukin-6, ferritin, leukocytes, neutrophils, lymphocytes, platelets, C-Reactive Protein, procalcitonin, lactate dehydrogenase, aspartate aminotransferase, creatinine, and D-dimer as important biomarkers of cytokine storm syndrome. Elevated levels of interleukin-6 and hyperferritinemia should be considered as red flags of systemic inflammation and poor prognosis in COVID-19.

scholarly journals Tocilizumab Treatment Reduces Mortality in Hospitalized Patients with COVID-19

2021 ◽  
Author(s):  
Saliaj ◽  
BCCCP BCPS PharmD Matthew Li ◽  
Rizzo ◽  
Nassar ◽  
Nso ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Conditional Logistic Regression ◽  
Standard Of Care ◽  
Blood Oxygen Saturation ◽  
Early Administration ◽  
Logistic Regression Models ◽  
Risk Of Mortality ◽  
Observational Cohort ◽  
And Gender ◽  
Retrospective Observational Cohort Study

Abstract Aims This study aimed to investigate the potential of tocilizumab therapy in minimizing mortality and mechanical ventilation (MV) requirements among hospitalized COVID-19 patients.Methods A single-center, retrospective, observational cohort study of 375 patients with severe COVID-19 (March 1 and April 22, 2020) included 150 patients treated with Tocilizumab and 225 consecutive control patients adjusted for age and gender. Both groups received concomitant standard of care treatments in addition to Tocilizumab. The statistical methods relied on survival analyses, conditional logistic regression models, and contingency analyses. The primary outcomes included in-hospital mortality and the MV requirement.Results Tocilizumab associated with improved in-hospital mortality (34.7% vs 46.7%, P = 0.0136) and lower requirement for MV on days 1, 3, and 5 after treatment (P = 0.005, P < 0.0001, and P = 0.0021, respectively). Lower mortality was observed if tocilizumab was administered within 48 hours after admission (P = 0.0226). Older age and low blood oxygen saturation on admission decreased the odds of survival (P < 0.005).Conclusion Our study demonstrates a significant reduction in mortality and decreased requirement of MV with tocilizumab treatment in addition to the standard of care. Early administration of Tocilizumab within 48 hours reduces the risk of mortality.

scholarly journals Correlation Between CRP Il-6 Level, Severity and Mortality in Patients with Covid-19 Infection in Indonesia

2021 ◽  
Vol 2 (4) ◽  
Author(s):  
Inge Andriani ◽  
Arie Utariani ◽  
Elizeus Hanindito ◽  
Prananda Surya Airlangga
Keyword(s):  
P Value ◽  
Test Results ◽  
Comorbid Disease ◽  
C Reactive Protein ◽  
Exclusion Criteria ◽  
Reactive Protein ◽  
Cohort Design ◽  
Observational Cohort ◽  
R Value ◽  
Complications And Mortality

Background: IL-6 plays an important role in the occurrence of cytokine storm and is the major inducer of C-reactive protein (CRP) gene expression in the liver. This study aims to analyze CRP and IL-6 levels as markers of severity and mortality in COVID-19 patients. Methods: 50 subjects met the inclusion and exclusion criteria; the study was conducted using a retrospective observational cohort design and analyzed using Spearman-Rho and Mann Whitney test. Results: There is relationship between CRP and the severity of COVID-19 with p value < 0.001 and r value 0.604. The severity of IL-6 and COVID-19 was also associated with a p-value of 0.017 and an R-value of 0.337. CRP was also associated with mortality with a p value of 0.004, where the baseline SOFA score was p < 0.001 and the r value was 0.551. IL-6 was associated with symptom onset with a p-value of 0.027 and an R-value of 0.314. Meanwhile, CRP and IL-6 were associated with mechanical ventilation treatment with p-values ​​of 0.013 and 0.027, respectively. CRP also has a strong correlation with IL-6 levels with p value < 0.001 and r value 0.557. Conclusion: Examination of CRP and IL-6 was associated with severity, complications and mortality in COVID-19 patients, except that IL-6 was not associated with mortality because it is influenced by the patient’s comorbid disease.

scholarly journals Predictors of intubation and mortality in COVID-19 patients: a retrospective study

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Tiziana Cena ◽  
Gianmaria Cammarota ◽  
Danila Azzolina ◽  
Michela Barini ◽  
Simona Bazzano ◽  
...  
Keyword(s):  
Lactate Dehydrogenase ◽  
Hospital Mortality ◽  
Invasive Mechanical Ventilation ◽  
Ground Glass Opacity ◽  
Lactate Dehydrogenase Level ◽  
University Hospital ◽  
Arterial Oxygen ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Hypoxemic Acute Respiratory Failure

Abstract Background Estimating the risk of intubation and mortality among COVID-19 patients can help clinicians triage these patients and allocate resources more efficiently. Thus, here we sought to identify the risk factors associated with intubation and intra-hospital mortality in a cohort of COVID-19 patients hospitalized due to hypoxemic acute respiratory failure (ARF). Results We included retrospectively a total of 187 patients admitted to the subintensive and intensive care units of the University Hospital “Maggiore della Carità” of Novara between March 1st and April 30th, 2020. Based on these patients’ demographic characteristics, early clinical and laboratory variables, and quantitative chest computerized tomography (CT) findings, we developed two random forest (RF) models able to predict intubation and intra-hospital mortality. Variables independently associated with intubation were C-reactive protein (p < 0.001), lactate dehydrogenase level (p = 0.018) and white blood cell count (p = 0.026), while variables independently associated with mortality were age (p < 0.001), other cardiovascular diseases (p = 0.029), C-reactive protein (p = 0.002), lactate dehydrogenase level (p = 0.018), and invasive mechanical ventilation (p = 0.001). On quantitative chest CT analysis, ground glass opacity, consolidation, and fibrosis resulted significantly associated with patient intubation and mortality. The major predictors for both models were the ratio between partial pressure of arterial oxygen and fraction of inspired oxygen, age, lactate dehydrogenase, C-reactive protein, glycemia, CT quantitative parameters, lymphocyte count, and symptom onset. Conclusions Altogether, our findings confirm previously reported demographic, clinical, hemato-chemical, and radiologic predictors of adverse outcome among COVID-19-associated hypoxemic ARF patients. The two newly developed RF models herein described show an overall good level of accuracy in predicting intra-hospital mortality and intubation in our study population. Thus, their future development and implementation may help not only identify patients at higher risk of deterioration more effectively but also rebalance the disproportion between resources and demand.

Sign in / Sign up

Export Citation Format

Share Document