Mortality Predictors Of Pre-variant SARS-CoV-2 Infected ARDS Patients Receiving Favipiravir and Tocilizumab
Fatma Yildirim, Meltem Şimşek, Muhammed Apaydin, İrem Karaman, Halil İbrahim Dural
doi:10.21203/rs.3.rs-1666161/v1
In this study, viral clearance (oronasopharyngeal swab RT-PCR negativity) and intensive care outcomes and risk factors affecting mortality of critically ill patients with COVID-19-related acute respiratory distress syndrome (ARDS) who received tocilizumab and favipiravir treatments together before vaccination were investigated.
Material-Methods The data of patients who were followed up and treated between 1 July 2020 and 5 October 2020 were retrospectively analyzed. Demographic data of the patients (age, gender), oro-nasopharyngeal swab RT-PCR and classi cation of ARDS, respiratory support treatments, all medical treatments, and ICU outcomes were recorded.
Results Totally, 60 patients with a median age of 69.8 [24-87], 25 females and 35 males were included in the study. Mean APACHE II score was 18.9 ± 8.0; and SOFA score was 4.5 ± 2.0. Thirty-four (56.7%) patients were intubated during follow-up. Tocilizumab was given on average of 2.5th day (± 2.0 days). On the day of tocilizumab administration, 1 (1.7%) patient had mild ARDS, 30 (50.0%) had moderate ARDS, 29 (48.3%) had severe ARDS. PaO2/FIO2 on the day of tocilizumab administration was 96.7 ± 36.6 mmHg. Forty (66.7%) patients died, while 20 (33.3%) patients transferred to the service. The mean length of stay in the ICU was 11.4 ± 5.5 days. Advanced age [Hazard ratio (HR) 1.8; 95% con dense interval (CI) 0.88-0.93; p < 0.001), higher APACHE II score (HR 0.81, 95% CI 0.74-0.98; p = 0.001), higher SOFA score on the day of tocilizumab administration (HR 1.47, 95% CI 0.39-0.79; p = 0.001), and lower PaO2/FIO2 ratio (HR 2.54, 95% CI 2.33-3.79; p < 0.001) were determined as independent risk factors for mortality.
Conclusion Patients who were administered tocilizumab and favipiravir together in our intensive care unit were mostly patients with severe ARDS and had higher in ammatory markers. High mortality was attributed to the use of tocilizumab as an add-on treatment, not as a routine treatment.
Declarations Con ict of interest The authors declare that there is no con ict of interest regarding the publication of this paper.
Ethics Statement This study was performed in accordance with the ethical principles in the Good Clinical Practice (GCP) guidelines and Declaration of Helsinki, applicable local regulatory requirements and the protocol were approved by Ethics Committee of tertiary institution.
Authors' contributions All authors have contributed su ciently in the conception and design of the study, data collection, and interpretation as well as the preparation of the manuscript. All authors read and approved the nal version of the manuscript.
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'abstract': '<jats:title>Abstract</jats:title>\n'
' <jats:p>Objective\n'
' In this study, viral clearance (oronasopharyngeal swab RT-PCR negativity) and intensive care '
'outcomes and risk factors affecting mortality of critically ill patients with '
'COVID-19-related acute respiratory distress syndrome (ARDS) who received tocilizumab and '
'favipiravir treatments together before vaccination were investigated.\n'
'Material-Methods\n'
' The data of patients who were followed up and treated between 1 July 2020 and 5 October 2020 '
'were retrospectively analyzed. Demographic data of the patients (age, gender), '
'oro-nasopharyngeal swab RT-PCR and classification of ARDS, respiratory support treatments, '
'all medical treatments, and ICU outcomes were recorded.\n'
'Results\n'
' Totally, 60 patients with a median age of 69.8 [24–87], 25 females and 35 males were '
'included in the study. Mean APACHE II score was 18.9\u2009±\u20098.0; and SOFA score was '
'4.5\u2009±\u20092.0. Thirty-four (56.7%) patients were intubated during follow-up. '
'Tocilizumab was given on average of 2.5th day (±\u20092.0 days). On the day of tocilizumab '
'administration, 1 (1.7%) patient had mild ARDS, 30 (50.0%) had moderate ARDS, 29 (48.3%) had '
'severe ARDS. PaO2/FIO2 on the day of tocilizumab administration was 96.7\u2009±\u200936.6 '
'mmHg. Forty (66.7%) patients died, while 20 (33.3%) patients transferred to the service. The '
'mean length of stay in the ICU was 11.4\u2009±\u20095.5 days. Advanced age [Hazard ratio (HR) '
'1.8; 95% confidense interval (CI) 0.88–0.93; p\u2009<\u20090.001), higher APACHE II score '
'(HR 0.81, 95% CI 0.74–0.98; p\u2009=\u20090.001), higher SOFA score on the day of tocilizumab '
'administration (HR 1.47, 95% CI 0.39–0.79; p\u2009=\u20090.001), and lower PaO2/FIO2 ratio '
'(HR 2.54, 95% CI 2.33–3.79; p\u2009<\u20090.001) were determined as independent risk '
'factors for mortality.\n'
'Conclusion\n'
' Patients who were administered tocilizumab and favipiravir together in our intensive care '
'unit were mostly patients with severe ARDS and had higher inflammatory markers. High '
'mortality was attributed to the use of tocilizumab as an add-on treatment, not as a routine '
'treatment.</jats:p>',
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