Anjum Hameed, Asif Mehmood, Muhammad Younus, Shahid Mahmood, Qamar Rafique, Maqsood Cheema, Rao Hashim Idrees, Amber Riaz.
Effect of tocilizumab in terms of hospital stay and mortality pattern among patients with severe versus critically-ill covid-19 patients: a comparative analytic study.
J Allama Iqbal Med Coll Jan ;20(1):55-9.

Background and Objectives: Most patients with mild and moderate COVID-19 infection recover with standard care therapy. Mortality in patients with severe illness and those critically ill is high. Tocilizumab acts by blocking interleukin-6 receptors and shows promising results in severe disease. Aim of this study was to assess the effect of Tocilizumab in severe and critically ill COVID-19 patients in terms hospital stay and reducing the risk of death. Methods: In this comparative analytical, single-center study undertaken in DHQ university teaching hospital Gujranwala, forty-four patients were enrolled after an informed consent through non-probability consecutive sampling. The patients were categorized based on oxygen requirement as severe (oxygen requirement 10 L/min) and critically ill patients (oxygen requirement 15 L/min). All patients were treated with injection Tocilizumab (8mg per kg body weight) using criteria based on oxygen requirement (10L/min or more) and increased levels of any two of the laboratory investigations including CRP, D-Dimers, serum ferritin and LDH. Sociodemographic and clinical profile were collected using a semi-structured proforma. Outcome of interest was hospital stay and mortality. Comparison of effect of Tocilizumab was analyzed in regards to age, sex, laboratory investigations and stated outcome using Pearson's Chi-squared test. P-value of <=0.05 was considered statistically significant. Data were analyzed using SPSS version 24.0. Results: Of 44 COVID-19 patients, 26 (59.1%) had severe disease and 18 (40.9%) were critically ill. We did not observe any statistical difference between these two categories as regards age, sex, hospital stay or presence of co-morbid conditions. However, there were 17 (94%) deaths observed among critically ill patients, while one patient died with severe disease. This mortality difference was found statistically significant (p<0.001). Conclusion: Tocillizumab has shown significant effect to reduce mortality and minimizing hospital stay amongst COVID-19 patients with severe disease only with minimal effect in critically ill patients. Tocilizumab may be introduced early in treatment plan for severe COVID-19 patients.

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