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

Abstract Background Cytokine storm is a marker of COVID-19 illness severity and increased mortality. Immunomodulatory treatments have been repurposed to improve mortality outcomes.Methods We 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.Results There 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).Conclusions When 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..

Medienart:

Preprint

Erscheinungsjahr:

2022

Erschienen:

2022

Enthalten in:

bioRxiv.org - (2022) vom: 29. Okt. Zur Gesamtaufnahme - year:2022

Sprache:

Englisch

Beteiligte Personen:

Narain, Sonali [VerfasserIn]
Stefanov, Dimitre G. [VerfasserIn]
Chau, Alice S. [VerfasserIn]
Weber, Andrew G. [VerfasserIn]
Marder, Galina [VerfasserIn]
Kaplan, Blanka [VerfasserIn]
Malhotra, Prashant [VerfasserIn]
Bloom, Ona [VerfasserIn]
Liu, Audrey [VerfasserIn]
Lesser, Martin L. [VerfasserIn]
Hajizadeh, Negin [VerfasserIn]

Links:

Volltext [kostenfrei]

Themen:

570
Biology

doi:

10.1101/2020.06.16.20126714

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

XBI01817793X