ntroduction.
Coronavirus infection 2019 (COVID-19) is
characterized by high morbidity and mortality. Interleu-
kin-6 receptor inhibitors, including tocilizumab, are used
for the anti-inflammatory therapy of COVID-19. The aim
of the study was to compare the clinical, lab and radia-
tion characteristics of surviving and deceased patients
with severe COVID-19 and pneumonia caused by SARS-
CoV-2 who received tocilizumab and identify features
that were associated with various outcomes.
Methods.
The medical records of 31 hospitalized COVID-19 pa-
tients were stu
died. All patients received a single dose of
tocilizumab 400 mg. Two groups were created. Group 1
included 17 patients who were discharged with improve-
ment, Group 2–14 fatal cases. The methods of parametric
and nonparametric statistics were used for processing.
Results.
The condition of patients from Group 2 more
often than in Group 1 was assessed as severe already at
admission, p=0.022. Only 4 patients from Group 1 and
all patients from Group 2 were allocated to the intensive
care unit; the mechanical ventilation was used exclusively
in group 2, p <0.001. The groups differed in terms of the
SpO2 le
vel, p=0.023, and the concentration of C-reactive
protein (CRP) at admission, p=0.047, as well as in the vo-
lume of lung tissue damage, p=0.027. Tocilizumab was
admi
nistered to all patients within a comparable period
from the onset of the disease. There was an increase in the
neutrophil/lymphocyte ratio in peripheral blood (NLR) by
the day of its administration in Group 2, p=0.026. The NLR
le vel increased even more significantly within 5–7 days
after administration, p=0.045 (p=0.007 compared to
baseline). The NLR value in Group 2 changed insigni-
ficantly. The blood ferritin level in patients from Group 1
by the day of tocilizumab administration was lower than
in Group 2, p=0.014, and decreased after the treatment,
p=0.01, in contrast to Group 2. The decrease in the CRP
concentration after the appointment of tocilizumab
in Group 1 was also significant, p=0.001.
Conclusions.
The deceased COVID-19 patients who received tocilizu-
mab were characterized, compared with the survivors,
by the initially more severe course of the disease, more
pronounced hypoxemia, as well as the volume of lung
tissue damage and laboratory abnormalities, inclu
ding
the le
vels of NLR, CRP and ferritin. Monitoring of these in-
dicators appears to be necessary to assess the course of
COVID-19 and make a decision on the anti-inflammatory
therapy with tocilizumab.
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