The Effects of Immunosuppressive Therapy on Mortality in Patients Followed in Intensive Care Units with the Diagnosis of Critical Coronavirus Disease-2019 Pneumonia

Abstract

Introduction:The efficacy and safety of immunosuppressive therapy in Coronavirus disease-2019 (COVID-19) still controversial. We evaluated the effects of immunosuppressive therapy on mortality in patients followed in the intensive care units (ICU) due to critical COVID-19 pneumonia.Methods:We compared patients followed up in the ICUs due to severe COVID-19 pneumonia who received immunosuppressive therapy with those who did not in terms of 1-month mortality, retrospectively.Results:A total of 362 patients followed up in ICUs with a diagnosis of critical COVID-19 pneumonia were included in the study. The patients were divided into two groups as patients who received immunosuppressive therapy [n=249, 165 patients (45.5%) who received only corticosteroids, 25 patients (7%) who received only tocilizumab, and 59 patients (16.5%) who received tocilizumab + corticosteroid] and patients who did not (n=113). One hundred and ninety-two of the patients died (54.1%). There was no statistical difference between the groups in terms of 1-month mortality (p=0.38). Secondary bacterial infection was detected in 25.1% (n=91) n of the patients. The frequency of secondary infections was higher in the patients who received immunosuppressive therapy than in patients who did not receive immunosuppressive therapy (28% vs 17% respectively, p=0.03). The most common secondary bacterial infection was detected in patients who received tocilizumab + corticosteroids (n=25, 42.2%).Conclusion:In this study, no difference in 1-month mortality was found between patients who received immunosuppressive therapy and those who did not. The frequency of secondary bacterial infections in patients who received immunosuppressive therapy was higher than in patients who did not.

Keywords

• covid-19
• immunosuppressive therapy
• tocilizumab
• corticosteroid
• mortality