Abstract: Clinical Microbiology and Infection 27 (2021) 244e252
Contents lists available at ScienceDirect
Clinical Microbiology and Infection
journal homepage: www.clinicalmicrobiologyandinfection.com
Original article
Treatment with tocilizumab or corticosteroids for COVID-19 patients
with hyperinflammatory state: a multicentre cohort study (SAMCOVID-19)
~ o 1, 2, 3, *, Jero
nimo Pacho
n 2, 3, 4, Jordi Carratala
5, 6, 7, Pablo Ryan 8,
Jesús Rodríguez-Ban
9
10
11
,
12
Ramo
n Arribas
, Juan Berenguer 13, 14, the
Inmaculada Jarrín , María Yllescas , Jose
y
SAM-COVID Study Group
1)
Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain
Departamento de Medicina, Universidad de Sevilla, Spain
3)
Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
4)
Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain
5)
Servei de Malalties Infeccioses, Hospital Universitari de Bellvitge, Barcelona, Spain
6)
n Biom
Instituto de Investigacio
edica de Bellvitge (IDIBELL), Barcelona, Spain
7)
Universitat de Barcelona, Barcelona, Spain
8)
Servicio de Medicina Interna, Hospital Universitario Infanta Leonor, Madrid, Spain
9)
Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
10)
n SEIMC/GeSIDA, Madrid, Spain
Fundacio
11)
Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
12)
n Hospital Universitario La Paz, Madrid, Spain
Instituto de Investigacio
13)
~o
n, Madrid, Spain
Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Maran
14)
n Sanitaria Gregorio Maran
~o
n (IiSGM), Madrid, Spain
Instituto de Investigacio
2)
a r t i c l e i n f o
a b s t r a c t
Article history:
Received 3 July 2020
Received in revised form
5 August 2020
Accepted 9 August 2020
Available online 27 August 2020
Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a
hyperinflammatory state according to clinical and laboratory parameters.
Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19
and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with
tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC),
combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days.
Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of
treatment weights (IPTWs).
Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy,
respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%),
27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio
for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22e0.47; p < 0.001) for tocilizumab, 0.82 (0.71e1.30; p 0.82) for IHDC, 0.61 (0.43e0.86; p 0.006) for PDC, and 1.17 (0.86e1.58; p 0.30)
for combination therapy. Other applications of the..
DOI record:
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