Journal of Clinical Medicine (Dec 2021)
Date of Admission during COVID-19 Pandemic Impacted Patient Outcomes in Addition to the Higher Efficacy of Tocilizumab Plus High-Dose Corticosteroid Therapy Compared to Tocilizumab Alone
- Moncef Belhassen-García,
- Antonio Sánchez-Puente,
- Pedro-Ignacio Dorado-Díaz,
- Amparo López-Bernús,
- Jesús Sampedro-Gómez,
- Raúl Azibeiro-Melchor,
- Edgard Marcano-Millán,
- Beatriz Rodríguez-Alonso,
- María-Elisa Sánchez-Barrado,
- Ignacio Hernández-García,
- Ignacio Madruga,
- Guillermo Hernández-Pérez,
- Cristina Carbonell,
- Judit García-Aparicio,
- Laura Burgos,
- Eugenia López-Sánchez,
- Carlos Reina,
- Ana-María Ramón,
- Laura Cestero-Ramírez,
- Fátima Boumhir,
- Daniel Encinas-Sánchez,
- María Sánchez-Ledesma,
- Jacinto Herráez,
- Patricia Araoz,
- María-José Sánchez-Crespo,
- Sandra Rodríguez-Rodríguez,
- Ana-Elisa Rodríguez-Gude,
- Miguel-Vicente Sánchez-Hernández,
- Rafael Borrás,
- Víctor Sagredo-Meneses,
- Pedro-Luis Sánchez,
- Miguel Marcos,
- José-Ángel Martín-Oterino
Affiliations
- Moncef Belhassen-García
- Infectious Diseases Unit, Department of Internal Medicine, University Hospital of Salamanca-IBSAL, 37007 Salamanca, Spain
- Antonio Sánchez-Puente
- Department of Cardiology, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- Pedro-Ignacio Dorado-Díaz
- Department of Cardiology, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- Amparo López-Bernús
- Infectious Diseases Unit, Department of Internal Medicine, University Hospital of Salamanca-IBSAL, 37007 Salamanca, Spain
- Jesús Sampedro-Gómez
- Department of Cardiology, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- Raúl Azibeiro-Melchor
- Department of Hematology, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- Edgard Marcano-Millán
- Department of Intensive Care Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- Beatriz Rodríguez-Alonso
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- María-Elisa Sánchez-Barrado
- Department of Anesthesiology and Reanimation, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- Ignacio Hernández-García
- Department of Preventive Medicine and Public Health, Lozano Blesa University Clinical Hospital of Zaragoza, 50009 Zaragoza, Spain
- Ignacio Madruga
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- Guillermo Hernández-Pérez
- Infectious Diseases Unit, Department of Internal Medicine, University Hospital of Salamanca-IBSAL, 37007 Salamanca, Spain
- Cristina Carbonell
- Infectious Diseases Unit, Department of Internal Medicine, University Hospital of Salamanca-IBSAL, 37007 Salamanca, Spain
- Judit García-Aparicio
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- Laura Burgos
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- Eugenia López-Sánchez
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- Carlos Reina
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- Ana-María Ramón
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- Laura Cestero-Ramírez
- Department of Intensive Care Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- Fátima Boumhir
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- Daniel Encinas-Sánchez
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- María Sánchez-Ledesma
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- Jacinto Herráez
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- Patricia Araoz
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- María-José Sánchez-Crespo
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- Sandra Rodríguez-Rodríguez
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- Ana-Elisa Rodríguez-Gude
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- Miguel-Vicente Sánchez-Hernández
- Department of Anesthesiology and Reanimation, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- Rafael Borrás
- Department of Emergency Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- Víctor Sagredo-Meneses
- Department of Intensive Care Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- Pedro-Luis Sánchez
- Department of Cardiology, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- Miguel Marcos
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- José-Ángel Martín-Oterino
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain
- DOI
- https://doi.org/10.3390/jcm11010198
- Journal volume & issue
-
Vol. 11,
no. 1
p. 198
Abstract
Background: The evidence for the efficacy of glucocorticoids combined with tocilizumab (TCZ) in COVID-19 comes from observational studies or subgroup analysis. Our aim was to compare outcomes between hospitalized COVID-19 patients who received high-dose corticosteroid pulse therapy and TCZ and those who received TCZ. Methods: A retrospective single-center study was performed on consecutive hospitalized patients with severe COVID-19 between 1 March and 23 April 2020. Patients treated with either TCZ (400–600 mg, one to two doses) and methylprednisolone pulses (MPD-TCZ group) or TCZ alone were analyzed for the occurrence of a combined endpoint of death and need for invasive mechanical ventilation during admission. The independence of both treatment groups was tested using machine learning classifiers, and relevant variables that were potentially different between the groups were measured through a mean decrease accuracy algorithm. Results: An earlier date of admission was significantly associated with worse outcomes regardless of treatment type. Twenty patients died (27.0%) in the TCZ group, and 33 (44.6%) died or required intubation (n = 74), whereas in the MPD-TCZ group, 15 (11.0%) patients died and 29 (21.3%) patients reached the combined endpoint (n = 136; p = 0.006 and p < 0.001, respectively). Machine learning methodology using a random forest classifier confirmed significant differences between the treatment groups. Conclusions: MPD and TCZ improved outcomes (death and invasive mechanical ventilation) among hospitalized COVID-19 patients, but confounding variables such as the date of admission during the COVID-19 pandemic should be considered in observational studies.
Keywords