Irene Coloretti, Stefano Busani, Emanuela Biagioni, Sophie Venturelli, Elena Munari, Marco Sita, Lorenzo DallAra, Martina Tosi, Enrico Clini, Roberto Tonelli, Riccardo Fantini, Cristina Mussini, Marianna Meschiari, Giovanni Guaraldi, Andrea Cossarizza, Gaetano Alfano, Massimo Girardis
{"title":"细胞因子阻滞剂对SARS-CoV-2感染急性呼吸窘迫综合征ICU住院患者住院死亡率的影响:回顾性队列研究","authors":"Irene Coloretti, Stefano Busani, Emanuela Biagioni, Sophie Venturelli, Elena Munari, Marco Sita, Lorenzo DallAra, Martina Tosi, Enrico Clini, Roberto Tonelli, Riccardo Fantini, Cristina Mussini, Marianna Meschiari, Giovanni Guaraldi, Andrea Cossarizza, Gaetano Alfano, Massimo Girardis","doi":"10.4081/mrm.2021.737","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The use of cytokine-blocking agents has been proposed to modulate the inflammatory response in patients with COVID-19. Tocilizumab and anakinra were included in the local protocol as an optional treatment in critically ill patients with acute respiratory distress syndrome (ARDS) by SARS-CoV-2 infection. This cohort study evaluated the effects of therapy with cytokine blocking agents on in-hospital mortality in COVID-19 patients requiring mechanical ventilation and admitted to intensive care unit.</p><p><strong>Methods: </strong>The association between therapy with tocilizumab or anakinra and in-hospital mortality was assessed in consecutive adult COVID-19 patients admitted to our ICU with moderate to severe ARDS. The association was evaluated by comparing patients who received to those who did not receive tocilizumab or anakinra and by using different multivariable Cox models adjusted for variables related to poor outcome, for the propensity to be treated with tocilizumab or anakinra and after patient matching.</p><p><strong>Results: </strong>Sixty-six patients who received immunotherapy (49 tocilizumab, 17 anakinra) and 28 patients who did not receive immunotherapy were included. The in-hospital crude mortality was 30,3% in treated patients and 50% in nontreated (OR 0.77, 95% CI 0.56-1.05, p=0.069). The adjusted Cox model showed an association between therapy with immunotherapy and in-hospital mortality (HR 0.40, 95% CI 0.19-0.83, p=0.015). This protective effect was further confirmed in the analysis adjusted for propensity score, in the propensity-matched cohort and in the cohort of patients with invasive mechanical ventilation within 2 hours after ICU admission.</p><p><strong>Conclusions: </strong>Although important limitations, our study showed that cytokine-blocking agents seem to be safe and to improve survival in COVID-19 patients admitted to ICU with ARDS and the need for mechanical ventilation.</p>","PeriodicalId":49031,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2021-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/84/30/mrm-16-1-737.PMC8139121.pdf","citationCount":"2","resultStr":"{\"title\":\"Effects of cytokine blocking agents on hospital mortality in patients admitted to ICU with acute respiratory distress syndrome by SARS-CoV-2 infection: retrospective cohort study.\",\"authors\":\"Irene Coloretti, Stefano Busani, Emanuela Biagioni, Sophie Venturelli, Elena Munari, Marco Sita, Lorenzo DallAra, Martina Tosi, Enrico Clini, Roberto Tonelli, Riccardo Fantini, Cristina Mussini, Marianna Meschiari, Giovanni Guaraldi, Andrea Cossarizza, Gaetano Alfano, Massimo Girardis\",\"doi\":\"10.4081/mrm.2021.737\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The use of cytokine-blocking agents has been proposed to modulate the inflammatory response in patients with COVID-19. Tocilizumab and anakinra were included in the local protocol as an optional treatment in critically ill patients with acute respiratory distress syndrome (ARDS) by SARS-CoV-2 infection. This cohort study evaluated the effects of therapy with cytokine blocking agents on in-hospital mortality in COVID-19 patients requiring mechanical ventilation and admitted to intensive care unit.</p><p><strong>Methods: </strong>The association between therapy with tocilizumab or anakinra and in-hospital mortality was assessed in consecutive adult COVID-19 patients admitted to our ICU with moderate to severe ARDS. The association was evaluated by comparing patients who received to those who did not receive tocilizumab or anakinra and by using different multivariable Cox models adjusted for variables related to poor outcome, for the propensity to be treated with tocilizumab or anakinra and after patient matching.</p><p><strong>Results: </strong>Sixty-six patients who received immunotherapy (49 tocilizumab, 17 anakinra) and 28 patients who did not receive immunotherapy were included. The in-hospital crude mortality was 30,3% in treated patients and 50% in nontreated (OR 0.77, 95% CI 0.56-1.05, p=0.069). The adjusted Cox model showed an association between therapy with immunotherapy and in-hospital mortality (HR 0.40, 95% CI 0.19-0.83, p=0.015). This protective effect was further confirmed in the analysis adjusted for propensity score, in the propensity-matched cohort and in the cohort of patients with invasive mechanical ventilation within 2 hours after ICU admission.</p><p><strong>Conclusions: </strong>Although important limitations, our study showed that cytokine-blocking agents seem to be safe and to improve survival in COVID-19 patients admitted to ICU with ARDS and the need for mechanical ventilation.</p>\",\"PeriodicalId\":49031,\"journal\":{\"name\":\"Multidisciplinary Respiratory Medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2021-05-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/84/30/mrm-16-1-737.PMC8139121.pdf\",\"citationCount\":\"2\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Multidisciplinary Respiratory Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.4081/mrm.2021.737\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2021/1/15 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Multidisciplinary Respiratory Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4081/mrm.2021.737","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2021/1/15 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 2
摘要
背景:已经提出使用细胞因子阻断剂来调节COVID-19患者的炎症反应。Tocilizumab和anakinra被纳入当地方案，作为SARS-CoV-2感染的急性呼吸窘迫综合征(ARDS)危重患者的可选治疗。本队列研究评估了细胞因子阻滞剂治疗对需要机械通气并入住重症监护病房的COVID-19患者住院死亡率的影响。方法:评估tocilizumab或anakinra治疗与院内死亡率之间的关系，这些患者连续入住ICU并伴有中度至重度ARDS。通过比较接受tocilizumab或anakinra治疗的患者与未接受tocilizumab或anakinra治疗的患者，并通过使用不同的多变量Cox模型来调整与不良结果相关的变量，以评估使用tocilizumab或anakinra治疗的倾向以及患者匹配后的相关性。结果:66例接受免疫治疗的患者(49例tocilizumab, 17例anakinra)和28例未接受免疫治疗的患者纳入研究。治疗组的住院粗死亡率为30.3%，未治疗组为50% (OR 0.77, 95% CI 0.56-1.05, p=0.069)。调整后的Cox模型显示免疫治疗与住院死亡率之间存在相关性(HR 0.40, 95% CI 0.19-0.83, p=0.015)。在倾向评分调整后的分析中，在倾向匹配队列中，在ICU入院后2小时内有创机械通气患者队列中，进一步证实了这种保护作用。结论:尽管存在重要的局限性，但我们的研究表明，细胞因子阻断剂似乎是安全的，并且可以提高ICU合并ARDS并需要机械通气的COVID-19患者的生存率。
Effects of cytokine blocking agents on hospital mortality in patients admitted to ICU with acute respiratory distress syndrome by SARS-CoV-2 infection: retrospective cohort study.
Background: The use of cytokine-blocking agents has been proposed to modulate the inflammatory response in patients with COVID-19. Tocilizumab and anakinra were included in the local protocol as an optional treatment in critically ill patients with acute respiratory distress syndrome (ARDS) by SARS-CoV-2 infection. This cohort study evaluated the effects of therapy with cytokine blocking agents on in-hospital mortality in COVID-19 patients requiring mechanical ventilation and admitted to intensive care unit.
Methods: The association between therapy with tocilizumab or anakinra and in-hospital mortality was assessed in consecutive adult COVID-19 patients admitted to our ICU with moderate to severe ARDS. The association was evaluated by comparing patients who received to those who did not receive tocilizumab or anakinra and by using different multivariable Cox models adjusted for variables related to poor outcome, for the propensity to be treated with tocilizumab or anakinra and after patient matching.
Results: Sixty-six patients who received immunotherapy (49 tocilizumab, 17 anakinra) and 28 patients who did not receive immunotherapy were included. The in-hospital crude mortality was 30,3% in treated patients and 50% in nontreated (OR 0.77, 95% CI 0.56-1.05, p=0.069). The adjusted Cox model showed an association between therapy with immunotherapy and in-hospital mortality (HR 0.40, 95% CI 0.19-0.83, p=0.015). This protective effect was further confirmed in the analysis adjusted for propensity score, in the propensity-matched cohort and in the cohort of patients with invasive mechanical ventilation within 2 hours after ICU admission.
Conclusions: Although important limitations, our study showed that cytokine-blocking agents seem to be safe and to improve survival in COVID-19 patients admitted to ICU with ARDS and the need for mechanical ventilation.
期刊介绍：
Multidisciplinary Respiratory Medicine is the official journal of the Italian Respiratory Society - Società Italiana di Pneumologia (IRS/SIP). The journal publishes on all aspects of respiratory medicine and related fields, with a particular focus on interdisciplinary and translational research.
The interdisciplinary nature of the journal provides a unique opportunity for researchers, clinicians and healthcare professionals across specialties to collaborate and exchange information. The journal provides a high visibility platform for the publication and dissemination of top quality original scientific articles, reviews and important position papers documenting clinical and experimental advances.
京公网安备 11010802042870号
京ICP备2023020795号-1
分享
求助内容：
应助结果提醒方式：
扫码关注我们
