Abstract
ObjectivesTo compare the outcome of severe COVID-19 patients treated with Tocilizumab (TCZ). Methods: A retrospective cohort study comparing the clinical characteristics and outcomes of patients who received TCZ with those who did not, was conducted at The Indus Hospital, Karachi. A sub-group analysis was conducted on the TCZ group to identify predictors of mortality. Results 88 patients including 41 patients in the TCZ group and 47 in non-TCZ group were recruited. Baseline characteristics were comparable. TCZ group patients presented with worse clinical features including median SpO2 82% vs 88%, p<0.05 and CRP 193 vs 133.9 mg/L, p<0.05. TCZ group showed severe bilateral chest x-ray findings (92% vs 31%, p<0.05) compared to non-TCZ. In the TCZ group 85.4% were admitted in ICU compared to 69.8% in non-TCZ group, p>0.05. Mortality was not different among the groups (46% in TCZ group vs 51.1% in non-TCZ group, p>0.05). Median length of hospital stay, days of intubation, use of inotropic agents, use of invasive ventilation or in-hospital complications were not different between the groups. Sub-group analysis revealed that mortality within TCZ group was associated with high IL-6 levels (173 vs 69.66 pg/ml, p<0.05), ICU admission (100% vs 72%, p<0.05), need for mechanical ventilation (100% vs 13.6%, p<0.05) and higher incidence of in-hospital complications, p<0.05. ConclusionTCZ group had more critical patients and TCZ failed to demonstrate any mortality benefit in these patients. Non-survivors within the TCZ group were more critical compared to survivors and developed higher proportion of in hospital complications
Clinical Efficacy of Intravenous Immunoglobulin Therapy in Critical Patients with COVID-19: A Multicenter Retrospective Cohort Study