Effect of Tocilizumab on “Ventilator Free Days” Composite Outcome in SARS-CoV-2 Patients: A Retrospective Competing Risk Analysis
Abstract
Background
SARS-CoV-2 infection demonstrates a wide range of severity. More severe cases demonstrate a cytokine storm with elevated serum interleukin-6, hence IL-6 receptor antibody tocilizumab was tried for the management of severe cases.
Aims
Effect of tocilizumab on ventilator-free days among critically ill SARS-CoV-2 patients.
Method
Retrospective propensity score matching study, comparing mechanically ventilated patients who received tocilizumab to a control group.
Results
29 patients in the intervention group were compared to 29 controls. Matched groups were similar. Ventilator-free days were more numerous in the intervention group (SHR 2.7, 95% CI: 1.2 – 6.3; p = 0.02), ICU mortality rate was not different (37.9% versus 62%, p = 0.1), actual ventilator-free periods were significantly longer in tocilizumab group (mean difference 4.7 days; p = 0.02). Sensitivity analysis showed a significantly lower hazard ratio of death in tocilizumab group (HR 0.49, 95% CI: 0.25 – 0.97; p = 0.04). There was no difference in positive cultures among groups (55.2% in tocilizumab group versus 34.5% in the control; p = 0.1).
Conclusion
Tocilizumab may improve the composite outcome of ventilator-free days at day 28 among mechanically ventilated SARS-CoV-2 patients; it is associated with significantly longer actual ventilator-free periods, and insignificantly lower mortality and higher superinfection.
© 2023 Ahmed F. Mady, Basheer Abdulrahman, Shahzad A. Mumtaz, Mohammed A. Al-Odat, Ahmed Kuhail, Rehab Altoraifi, Rayan Alshae, Abdulrahman M. Alharthy, Dimitrios Karakitsos, Waleed Th. Aletreby, published by Sciendo
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