SESSION TITLE: Respiratory Infections: What have We Learned About COVID-19 and New Trial Data for Management of Aspergilloma
SESSION TYPE: Original Investigations
PRESENTED ON: October 18-21, 2020
PURPOSE: Since cytokine release syndrome with elevation of interleukin-6 (IL-6) is considered to be associated with severe cases of COVID-19, IL-6 inhibitors are expected to be effective for its treatment. We aim to investigate and extract the prognostic factors from inflammatory markers and to evaluate effect of IL-6 inhibitors.
METHODS: The consecutive 224 hospitalized patients with confirmed COVID19 patients were retrospectively analyzed. Patients were divided into those who needed the intensive care unit (ICU group) and those who did not (no ICU group). D-dimer and IL-6 at admission and peak were collected. A multivariate logistic regression analysis was performed to assess the predictor for in-hospital mortality including IL-6.
RESULTS: The ICU group had higher rates of preexisting comorbidities than no ICU group and also had higher inflammatory makers including IL-6 compared to no ICU group (all P<0.05). Notably, age, IL-6/d-dimer (at peak) were significant predictors to estimate in-hospital death (1.05 [1.01-1.09], P=0.012, 1.001 [1.000-1.002], P=0.002, 1.10 [1.03-1.18], P=0.008). Receiver operating characteristics curve shows higher predictability to estimate in-hospital mortality with IL-6 at peak than others (area under curve; IL-6 at peak: 0.875 [0.87-0.942], IL-6 at admission: 0.794 [0.699-0.889], d-dimer at peak 0.787 [0.690-0.883], d-dimer at admission 0.726 [0.625- 0.827]). Interestingly, incidence of fungal infections was significantly higher in patients who was given tocilizumab than who was not (13.0% vs 1.1%, P<0.001). To estimate the effect of tocilizumab, inverse probability weighted analysis was also performed. Tocilizumab did not decrease or increase in-hospital mortality after adjustment including IL-6 (OR [95% CI]: 1.00 [0.27-3.72, P=0.998]).
CONCLUSIONS: We report the detailed description of clinical characteristics, especially ICU versus no ICU admission in the diverse urban city of New York. Age, IL-6/d-dimer (at peak) were significant predictors to estimate in-hospital death. Serial measurements of IL-6/d-dimer might be useful to estimate in-hospital mortality. Tocilizumab did not show decrease risk of in-hospital mortality.
CLINICAL IMPLICATIONS: Age, IL-6/d-dimer (at peak) were significant predictors to estimate in-hospital death. Serial measurements of IL-6/d-dimer might be useful to estimate in-hospital mortality. Tocilizumab did not show decrease risk of in-hospital mortality.
DISCLOSURES: No relevant relationships by Toshiki Kuno, source=Web Response
No relevant relationships by Tetsuro Maeda, source=Web Response
No relevant relationships by Reiichiro Obata, source=Web Response
No relevant relationships by Dahlia Rizk, source=Web Response