Turkish Thoracic Journal
Original Article

Clinical Predictors of Response to Tocilizumab: A Retrospective Multicenter Study

1.

Department of Pulmonology Medicine, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey

2.

Department of Pulmonology Medicine, Faculty of Medicine, Ege University, İzmir, Turkey

3.

Department of Pulmonology Medicine, Faculty of Medicine, Atatürk University, Erzurum, Turkey

4.

Department of Pulmonary Medicine, Florence Nightingale Hospital, İstanbul, Turkey

Turk Thorac J 2022; 23: 225-230
DOI: 10.5152/TurkThoracJ.2022.21179
Read: 455 Downloads: 146 Published: 01 May 2022

OBJECTIVE: A substantial number of patients with coronavirus disease-2019 (COVID-19) demonstrate severe infection. Cytokine storm is an underlying condition that worsens clinical outcomes. As an interleukin-6 receptor antagonist, tocilizumab is a promising treatment option for COVID-19. This study aimed to evaluate the clinical predictors of mortality for critically ill COVID-19 patients receiving tocilizumab therapy.

MATERIAL AND METHODS: The retrospective cohort study was conducted in 4 centers’ both wards and intensive care units between March 20 and May 20, 2020. Demographic, clinical, and laboratory data were consecutively drawn from medical records. The primary endpoint was in-hospital mortality.

RESULTS: In this study, 39 patients (28.2% female) were included, and the mortality rate was 25.6% (n = 10). There was statistically significant difference between survivor and non-survivor groups regarding age (53.0 (46.5-65.0) vs. 75.0 (68.25-81.25), respectively,P = .001), CALL score (8.0 (7.0-10.0) vs. 12.0 (9.75-13.0), P = .001), GRAM score (119.5 (99.5-142.0) vs. 155.0 (129.8-226.0), P = .004), and white blood cell count (k/mL) (5.6 (3.8-8.6) vs. 8.0 (7.6-9.3), P = .003). The patients who were on invasive mechanical ventilation at the time of tocilizumab administration had a higher mortality rate (100% vs. 25.9%, P < .001). Besides, arterial partial pressure of oxygen/ fraction of inspiratory oxygen (PaO2/FiO2) ratio on day 7, but not on days 0, 1, and 3 of tocilizumab therapy, was associated with mortal- ity. C-reactive protein (mg/dL) tended to be lower in the survivor group; however, it was not statistically significant (68.4 (32.7-157.5) vs. 113.5 (77.7-219.0), P = .058).

CONCLUSION: This study demonstrated that advanced age, increased leukocyte count, higher CALL and GRAM scores, and the need for invasive mechanical ventilation revealed a worse prognosis after tocilizumab treatment.

Cite this article as: Ercan S, Ergan B, Özuygur SS, et al. Clinical predictors of response to tocilizumab: A retrospective multicenter study. Turk Thorac J. 2022;23(3):225-230.

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