International Journal of Infectious Diseases (Dec 2020)
Beneficial effect of corticosteroids in preventing mortality in patients receiving tocilizumab to treat severe COVID-19 illness
- Manuel Rubio-Rivas,
- Mar Ronda,
- Ariadna Padulles,
- Francesca Mitjavila,
- Antoni Riera-Mestre,
- Carlos García-Forero,
- Adriana Iriarte,
- Jose M. Mora,
- Nuria Padulles,
- Monica Gonzalez,
- Xavier Solanich,
- Merce Gasa,
- Guillermo Suarez-Cuartin,
- Joan Sabater,
- Xose L. Perez-Fernandez,
- Eugenia Santacana,
- Elisabet Leiva,
- Albert Ariza-Sole,
- Paolo D. Dallaglio,
- Maria Quero,
- Antonio Soriano,
- Alberto Pasqualetto,
- Maylin Koo,
- Virginia Esteve,
- Arnau Antoli,
- Rafael Moreno-Gonzalez,
- Sergi Yun,
- Pau Cerda,
- Mariona Llaberia,
- Francesc Formiga,
- Marta Fanlo,
- Abelardo Montero,
- David Chivite,
- Olga Capdevila,
- Ferran Bolao,
- Xavier Pinto,
- Josep Llop,
- Antoni Sabate,
- Jordi Guardiola,
- Josep M. Cruzado,
- Josep Comin-Colet,
- Salud Santos,
- Ramon Jodar,
- Xavier Corbella
Affiliations
- Manuel Rubio-Rivas
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain; Corresponding authors at: Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, 08907 L’Hospitalet de Llobregat, Barcelona, Spain.
- Mar Ronda
- Department of Pharmacy, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Ariadna Padulles
- Department of Pharmacy, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Francesca Mitjavila
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Antoni Riera-Mestre
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Carlos García-Forero
- School of Medicine, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
- Adriana Iriarte
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Jose M. Mora
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Nuria Padulles
- Department of Pharmacy, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Monica Gonzalez
- Department of Pharmacy, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Xavier Solanich
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Merce Gasa
- Department of Pulmonary Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain; Research Network in Respiratory Diseases (CIBERES), Madrid, Spain
- Guillermo Suarez-Cuartin
- Department of Pulmonary Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain; Research Network in Respiratory Diseases (CIBERES), Madrid, Spain
- Joan Sabater
- Department of Intensive Care, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain; Innate Immunity and Pathology of Critical Patient-IDIBELL, Barcelona, Spain
- Xose L. Perez-Fernandez
- Department of Intensive Care, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain; Innate Immunity and Pathology of Critical Patient-IDIBELL, Barcelona, Spain
- Eugenia Santacana
- Department of Pharmacy, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Elisabet Leiva
- Department of Pharmacy, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Albert Ariza-Sole
- Department of Cardiology, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Paolo D. Dallaglio
- Department of Cardiology, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Maria Quero
- Department of Nephrology, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Antonio Soriano
- Department of Gastroenterology, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Alberto Pasqualetto
- Department of Anesthesiology and Reanimation, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Maylin Koo
- Department of Anesthesiology and Reanimation, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Virginia Esteve
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Arnau Antoli
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Rafael Moreno-Gonzalez
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Sergi Yun
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Pau Cerda
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Mariona Llaberia
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Francesc Formiga
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Marta Fanlo
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Abelardo Montero
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- David Chivite
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Olga Capdevila
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Ferran Bolao
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Xavier Pinto
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Josep Llop
- Department of Pharmacy, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Antoni Sabate
- Department of Anesthesiology and Reanimation, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Jordi Guardiola
- Department of Gastroenterology, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Josep M. Cruzado
- Department of Nephrology, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Josep Comin-Colet
- Department of Cardiology, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Salud Santos
- Department of Pulmonary Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain; Research Network in Respiratory Diseases (CIBERES), Madrid, Spain
- Ramon Jodar
- Department of Pharmacy, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Xavier Corbella
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain; School of Medicine, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain; Corresponding authors at: Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, 08907 L’Hospitalet de Llobregat, Barcelona, Spain.
- Journal volume & issue
-
Vol. 101
pp. 290 – 297
Abstract
Objectives: To assess the characteristics and risk factors for mortality in patients with severe coronavirus disease-2019 (COVID-19) treated with tocilizumab (TCZ), alone or in combination with corticosteroids (CS). Methods: From March 17 to April 7, 2020, a real-world observational retrospective analysis of consecutive hospitalized adult patients receiving TCZ to treat severe COVID-19 was conducted at our 750-bed university hospital. The main outcome was all-cause in-hospital mortality. Results: A total of 1,092 patients with COVID-19 were admitted during the study period. Of them, 186 (17%) were treated with TCZ, of which 129 (87.8%) in combination with CS. Of the total 186 patients, 155 (83.3 %) patients were receiving noninvasive ventilation when TCZ was initiated. Mean time from symptoms onset and hospital admission to TCZ use was 12 (±4.3) and 4.3 days (±3.4), respectively. Overall, 147 (79%) survived and 39 (21%) died. By multivariate analysis, mortality was associated with older age (HR = 1.09, p < 0.001), chronic heart failure (HR = 4.4, p = 0.003), and chronic liver disease (HR = 4.69, p = 0.004). The use of CS, in combination with TCZ, was identified as a protective factor against mortality (HR = 0.26, p < 0.001) in such severe COVID-19 patients receiving TCZ. No serious superinfections were observed after a 30-day follow-up. Conclusions: In patients with severe COVID-19 receiving TCZ due to systemic host-immune inflammatory response syndrome, the use of CS in addition to TCZ therapy, showed a beneficial effect in preventing in-hospital mortality.
