The role of IL-6 receptor inhibitor treatment in critical patient monitoring with COVID-19
1Department of Anesthesiology and Reanimation, University of Health Sciences, İstanbul Kartal Dr. Lütﬁ Kırdar City Hospital, 34865 Istanbul, Turkey
2Department of Anesthesiology and Reanimation, University of Marmara, 34722 Istanbul, Turkey
DOI: 10.22514/sv.2021.068 Vol.17,Issue 3,May 2021 pp.174-180
Submitted: 17 February 2021 Accepted: 15 March 2021
Published: 08 May 2021
*Corresponding Author(s): Fulya Çiyiltepe E-mail: firstname.lastname@example.org
Objectives: The COVID-19 disease can manifest itself with acute respiratory distress syndrome, renal failure, and septic shock in critically ill patients. There are opinions that there is a correlation between high IL-6 levels and disease severity. In our intensive care unit, we evaluated the changes in the laboratory data and radiological involvement severity of our patients who underwent tocilizumab treatment and examined the appropriate laboratory parameter in the treatment follow-up and its effect on survival.
Methods: In the critical patient follow-up of COVID-19, 17 of the 23 patients treated with tocilizumab had a mortal course (Group 1) and the remaining 6 (Group 2) were. The C-reactive protein, lactate dehydrogenase, IL-6, D-dimer, procalcitonin, albumin, and ferritin values, which were routinely screened in our clinic on the day of tocilizumab treatment and the 5th day after, were recorded. Both the change between the two groups and the change between days 1 and 5 were analyzed.
Results: A total of 23 patients (55.35 ± 13.31 years) were included in the study. The computed tomography severity score assessed at the intensive care unit admission was statistically significantly higher in Group 2. The procalcitonin and lactate dehydrogenase values measured on day 5 after tocilizumab were significantly lower in Group 2. On the 5th day after treatment, the levels of C-reactive protein, ferritin, chest X-rays, IL-6 and D-dimer statistically significantly changed compared to the first day of the treatment. In correlation with the decrease in PCT as of the 5th day after tocilizumab administration, an increasing tendency was observed in 28-day survival.
Conclusion: This study demonstrated that tocilizumab treatment may positively contribute to the treatment by decreasing cytokine levels. PCT and LDH follow-up before and after treatment in critically ill patients who are receiving tocilizumab treatment can give an idea about survival.
Coronavirus; IL-6 receptor inhibitor; Intensive care units; Tocilizumab; LDH; PCT; CRP
Fulya Çiyiltepe,Ayten Saraçoğlu,Yeliz Bilir,Elif Akova Deniz,Elif Bombacı,Kemal Tolga Saraçoğlu. The role of IL-6 receptor inhibitor treatment in critical patient monitoring with COVID-19. Signa Vitae. 2021. 17(3);174-180.
 Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet. 2020; 395: 507–513.
 Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID-19: consider cytokine storm syndromes and immunosuppres-sion. The Lancet. 2020; 395: 1033–1034.
 Aziz M, Fatima R, Assaly R. Elevated interleukin‐6 and severe COVID-19: a meta-analysis. Journal of Medical Virology. 2020; 92: 2283–2285.
 Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult in patients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020; 395: 1054–1062.
 Zhang S, Li L, Shen A, Chen Y, Qi Z. Rational use of tocilizumab in the treatment of novel coronavirus pneumonia. Clinical Drug Investigation. 2020; 40: 511–518.
 Gupta S, Wang W, Hayek SS, Chan L, Mathews KS, Melamed ML, et al. Association between early treatment with tocilizumaband mortality among critically ill patients with COVID-19. JAMA Internal Medicine. 2021;181: 41–51.
 Rosas IO, Bräu N, Waters M, Go RC, Hunter BD, Bhagani S, et al. Tocilizumab in hospitalizedpatientswith severe COVID-19 pneumonia. The New England Journal of Medicine. 2021. (in press)
 Salama C, Han J, Yau L, Reiss WG, Kramer B, Neidhart JD, et al. Tocilizumab in patients hospitalized with COVID-19 pneumonia. New England Journal of Medicine. 2021; 384: 20–30.
 Genentech. Prescribing information. ACTEMRA® (tocilizumab) injection, for intravenous or subcutaneous use. 2019. Available at: https://www.gene.com/download/pdf/actemra_prescribing. pdf (Accessed: 11 March 2020).
 Gordon AC, Mouncey PR, Al-Beidh F, Rowan KM, Nichol AD, Arabi YM, et al. Interleukin-6 receptor antagonists in critically ill patients with COVID-19. The New England Journal of Medicine. 2021. (in press)
 Tung-Chen Y, Martí de Gracia M, Díez-Tascón A, Alonso-González R, Agudo-Fernández S, Parra-Gordo ML, et al. Correlation between chest computed tomography and lung ultrasonography in patients with coronavirus disease 2019 (COVID-19). Ultrasound in Medicine & Biology. 2020; 46: 2918–2926.
 Zhang R, Ouyang H, Fu L, Wang S, Han J, Huang K, et al. CT features of SARS-CoV-2 Pneumonia according to clinical presentation: a retrospective analysis of 120 consecutive patients from Wuhan city. European Radiology. 2020; 30: 4417–4426.
 De Wever W, Meersschaert J, Coolen J, Verbeken E, Verschakelen JA. The crazy-paving pattern: a radiological-pathological correlation. Insights into Imaging. 2011; 2: 117–132.
 Pan F, Ye T, Sun P, Gui S, Liang B, Li L, et al. Time course of lung changes at chest ct during recovery from coronavirus disease 2019 (COVID-19). Radiology. 2020; 295: 715–721.
 Geaorge D, Marrey P. IBM SPSS statistics 25 step by step: a simple guide and reference. 15th edition. NY: Routledge. 2018.
 Lan S, Lai C, Huang H, Chang S, Lu L, Hsueh P. Tocilizumab for severe COVID-19: a systematic review and meta-analysis. International Journal of Antimicrobial Agents. 2020; 56: 106103.
 Grasselli G, Greco M, Zanella A, Albano G, Antonelli M, Bellani G, et al. Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy. JAMA Internal Medicine. 2020; 180: 1345.
 Chiaretti A, Pulitanò S, Barone G, Ferrara P, Romano V, Capozzi D, et al. IL-1 β and IL-6 upregulation in children with H1N1 influenza virus infection. Mediators of Inflammation. 2013; 2013: 495848.
 Luo P, Liu Y, Qiu L, Liu X, Liu D, Li J. Tocilizumab treatment in COVID-19: a single center experience. Journal of Medical Virology. 2020; 92: 814–818.
 Nishimoto N, Terao K, Mima T, Nakahara H, Takagi N, Kakehi T. Mechanisms and pathologic significances in increase in serum interleukin-6 (IL-6) and soluble IL-6 receptor after administration of an anti-IL-6 receptor antibody, tocilizumab, in patients with rheumatoid arthritis and Castleman disease. Blood. 2008; 112: 3959–3964.
 Toniatia P, Pivab S, Cattalinid M, Garrafaf E, Regolaa F, CastellieF, et al. Tocilizumab for the treatment of severe COVID-19 Pneumonia with hyperinflammatory syndrome and acute respiratory failure: a single center study of 100 patients in Brescia, Italy. Autoimmunity Reviews. 2020; 19: 102568.
 Liu T, Zhang J, Yang Y, Ma H, Li Z, Zhang J, et al. The potential role of IL-6 in monitoring severe case of coronavirus disease 2019. medRxiv. 2020. (in press)
 Moreno-Pérez O, Andres M, Leon-Ramirez J, Sánchez-Payá J, Rodríguez JC, Sánchez R, et al. Experience with tocilizumab in severe COVID-19 Pneumonia after 80 days of follow-up: a retrospective cohort study. Journal of Autoimmunity. 2020; 114: 102523.
 Hanley B, Lucas SB, Youd E, Swift B, Osborn M. Autopsy in suspected COVID-19 cases. Journal of Clinical Pathology. 2020; 73: 239–242.
 Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological find-ings of COVID-19 associated with acute respiratory distress syndrome. The Lancet Respiratory Medicine. 2020; 8: 420–422.
 McGonagle D, Sharif K, O’Regan A, Bridgewood C. The role of cytokines including Interleukin-6 in COVID-19 induced pneumonia and macrophage activation syndrome-like disease. Autoimmunity Reviews. 2020; 19: 102537.
 Ruscitti P, Berardicurti O, Di Benedetto P, Cipriani P, Iagnocco A, Shoenfeld Y, et al. Severe COVID-19, another piece in the puzzle of the hyperferritinemic syndrome. An immunomodulatory perspective to alleviate the storm. Frontiers in Immunology. 2020; 11: 1130.
 Duan K, Liu B, Li C, Zhang H, Yu T, QuJ, et al. The feasibility of convalescent plasma therapy in severe COVID-19 patients: a pilot study. medRxiv. 2020. (in press)
 Li L, Zhang W, Hu Y, Tong X, Zheng S, Yang J, et al. Effect of
convalescent plasmatherapy on time to clinical improvement in patients with severe and life-threatening COVID-19: a randomized clinical trial. The Journal of the American Medical Association. 2020; 324: 460-470.
Vol., Issue , Invalid dateTable of contents
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus: CiteScore 0.5(2021) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.