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pmid33275095      Clin+Exp+Rheumatol 2020 ; 38 (6): 1215-1222
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  • Acute-phase reactants during tocilizumab therapy for severe COVID-19 pneumonia #MMPMID33275095
  • Cassone G; Dolci G; Besutti G; Muratore F; Bajocchi G; Mancuso P; Catanoso M; Spaggiari L; Galli E; Palermo A; Pipitone N; Croci S; Massari M; Facciolongo N; Menzella F; Negri EA; Zerbini A; Belloni L; Cimino L; Teopompi E; Sampaolesi F; Salsi P; Costantini M; Giorgi Rossi P; Aldigeri R; Salvarani C
  • Clin Exp Rheumatol 2020[Nov]; 38 (6): 1215-1222 PMID33275095show ga
  • 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.
  • |*Betacoronavirus[MESH]
  • |*COVID-19 Drug Treatment[MESH]
  • |*Coronavirus Infections[MESH]
  • |*Pneumonia, Viral[MESH]
  • |Acute-Phase Proteins[MESH]
  • |Antibodies, Monoclonal, Humanized[MESH]
  • |Humans[MESH]
  • |Pandemics[MESH]
  • |Prospective Studies[MESH]


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