Acute-phase reactants during tocilizumab therapy for severe COVID-19 pneumonia
OBJECTIVES: To identify predictors of clinical improvement and intubation/death in tocilizumab-treated severe COVID19, focusing on IL6 and CRP longitudinal monitoring.
METHODS: 173 consecutive patients with severe COVID-19 pneumonia receiving tocilizumab in Reggio Emilia province Hospitals between 11 March and 3 June 2020 were enrolled in a prospective cohort study. Clinical improvement was defined as status improvement on a six-category ordinal scale or discharge from the hospital, whichever came first. A composite outcome of intubation/death was also evaluated. CRP and IL-6 levels were determined before TCZ administration (T0) and after 3 (T3), and 7 (T7) days.
RESULTS: At multivariate analysis T0 and T3 CRP levels were negatively associated with clinical improvement (OR 0.13, CI 0.03-0.55 and OR 0.11, CI 0.0-0.46) (p=0.006 and p=0.003) and positively associated with intubation/death (OR 17.66, CI 2.47-126.14 and OR 5.34, CI: 1.49-19.12) (p=0.01 and p=0.004). No significant associations with IL-6 values were observed. General linear model analyses for repeated measures showed significantly different trends for CRP from day 3 to day 7 between patients who improved and those who did not, and between patients who were intubated or died and those who were not (p<0.0001 for both). ROC analysis identified a baseline CRP level of 15.8 mg/dl as the best cut-off to predict intubation/death (AUC = 0.711, sensitivity = 0.67, specificity = 0.71).
CONCLUSIONS: CRP serial measurements in the first week of TCZ therapy are useful in identifying patients developing poor outcomes.
| Medienart: |
Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:38 |
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| Enthalten in: |
Clinical and experimental rheumatology - 38(2020), 6 vom: 04. Nov., Seite 1215-1222 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Cassone, Giulia [VerfasserIn] |
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| Themen: |
Acute-Phase Proteins |
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| Anmerkungen: |
Date Completed 08.12.2020 Date Revised 07.12.2022 published: Print-Electronic Citation Status MEDLINE |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM318411156 |
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| 100 | 1 | |a Cassone, Giulia |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Acute-phase reactants during tocilizumab therapy for severe COVID-19 pneumonia |
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| 500 | |a Date Completed 08.12.2020 | ||
| 500 | |a Date Revised 07.12.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a OBJECTIVES: To identify predictors of clinical improvement and intubation/death in tocilizumab-treated severe COVID19, focusing on IL6 and CRP longitudinal monitoring | ||
| 520 | |a METHODS: 173 consecutive patients with severe COVID-19 pneumonia receiving tocilizumab in Reggio Emilia province Hospitals between 11 March and 3 June 2020 were enrolled in a prospective cohort study. Clinical improvement was defined as status improvement on a six-category ordinal scale or discharge from the hospital, whichever came first. A composite outcome of intubation/death was also evaluated. CRP and IL-6 levels were determined before TCZ administration (T0) and after 3 (T3), and 7 (T7) days | ||
| 520 | |a RESULTS: At multivariate analysis T0 and T3 CRP levels were negatively associated with clinical improvement (OR 0.13, CI 0.03-0.55 and OR 0.11, CI 0.0-0.46) (p=0.006 and p=0.003) and positively associated with intubation/death (OR 17.66, CI 2.47-126.14 and OR 5.34, CI: 1.49-19.12) (p=0.01 and p=0.004). No significant associations with IL-6 values were observed. General linear model analyses for repeated measures showed significantly different trends for CRP from day 3 to day 7 between patients who improved and those who did not, and between patients who were intubated or died and those who were not (p<0.0001 for both). ROC analysis identified a baseline CRP level of 15.8 mg/dl as the best cut-off to predict intubation/death (AUC = 0.711, sensitivity = 0.67, specificity = 0.71) | ||
| 520 | |a CONCLUSIONS: CRP serial measurements in the first week of TCZ therapy are useful in identifying patients developing poor outcomes | ||
| 650 | 4 | |a Journal Article | |
| 650 | 7 | |a Acute-Phase Proteins |2 NLM | |
| 650 | 7 | |a Antibodies, Monoclonal, Humanized |2 NLM | |
| 650 | 7 | |a tocilizumab |2 NLM | |
| 650 | 7 | |a I031V2H011 |2 NLM | |
| 700 | 1 | |a Dolci, Giovanni |e verfasserin |4 aut | |
| 700 | 1 | |a Besutti, Giulia |e verfasserin |4 aut | |
| 700 | 1 | |a Muratore, Francesco |e verfasserin |4 aut | |
| 700 | 1 | |a Bajocchi, Gianluigi |e verfasserin |4 aut | |
| 700 | 1 | |a Mancuso, Pamela |e verfasserin |4 aut | |
| 700 | 1 | |a Catanoso, Mariagrazia |e verfasserin |4 aut | |
| 700 | 1 | |a Spaggiari, Lucia |e verfasserin |4 aut | |
| 700 | 1 | |a Galli, Elena |e verfasserin |4 aut | |
| 700 | 1 | |a Palermo, Adalgisa |e verfasserin |4 aut | |
| 700 | 1 | |a Pipitone, Nicolò |e verfasserin |4 aut | |
| 700 | 1 | |a Croci, Stefania |e verfasserin |4 aut | |
| 700 | 1 | |a Massari, Marco |e verfasserin |4 aut | |
| 700 | 1 | |a Facciolongo, Nicola |e verfasserin |4 aut | |
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| 700 | 1 | |a Zerbini, Alessandro |e verfasserin |4 aut | |
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| 700 | 1 | |a Teopompi, Elisabetta |e verfasserin |4 aut | |
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| 700 | 1 | |a Costantini, Massimo |e verfasserin |4 aut | |
| 700 | 1 | |a Giorgi Rossi, Paolo |e verfasserin |4 aut | |
| 700 | 1 | |a Aldigeri, Raffaella |e verfasserin |4 aut | |
| 700 | 1 | |a Salvarani, Carlo |e verfasserin |4 aut | |
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