Rationale
As clinical immunologists, we are experts in immune dysregulation as we regularly treat patients with combined immune deficiency and autoimmunity. This places us in a unique position to understand the nuances of COVID-19 immune disturbances, including cytokine release syndrome, and make recommendations regarding treatment.
Methods
At our institution, Allergy and Immunology faculty and fellows participated on a multidisciplinary COVID-19 treatment team whose role was to develop and revise a treatment algorithm for admitted patients and review patient charts under a stewardship module in the EMR. Outcome data for patients admitted with SARS-CoV-2 infection from March 10 to 31, 2020 was analyzed. Severe disease was defined as requiring at least 3L of oxygen to maintain SpO2 >93%.
Results
A treatment algorithm with recommendation for tocilizumab for patients requiring 3L/min of oxygen or greater to maintain SpO2 >93% was developed. The treatment algorithm included consideration of Allergy and Immunology consultation if there was need for repeat or alternative biologic agents. A total of 239 patients with PCR-confirmed SARS-CoV-2 infection were included. 153 of 239 patients received tocilizumab. Of all patients, 25 of 239 died, for an overall mortality rate of 10.5%. Among tocilizumab-treated patients requiring mechanical ventilation, survival was 75% (95% CI, 64-89).
Conclusions
The presence of a multidisciplinary treatment team, treatment algorithm, and stewardship module involving Allergy and Immunology was associated with favorable mortality outcomes for patients affected by COVID-19. Involvement of Allergy fellows on the multidisciplinary team supported learning opportunities for fellows via collaboration with other specialists.
359