Tocilizumab reduces the risk of ICU admission and mortality in patients with SARS-CoV-2 infection
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Abstract
Objectives. In some patients the immune response triggered by SARS-CoV-2 is unbalanced, presenting an acute respiratory distress syndrome which in many cases requires intensive care unit (ICU) admission. The limitation of ICU beds has been one of the major burdens in the management around the world; therefore, clinical strategies to avoid ICU admission are needed. We aimed to describe the influence of tocilizumab on the need of transfer to ICU or death in non-critically ill patients. Material and methods. A retrospective study of 171 patients with SARS-CoV-2 infection that did not qualify as requiring transfer to ICU during the first 24h after admission to a conventional ward, were included. The criteria to receive tocilizumab was radiological impairment, oxygen demand or an increasing of inflammatory parameters, however, the ultimate decision was left to the attending physician judgement. The primary outcome was the need of ICU admission or death whichever came first. Results. A total of 77 patients received tocilizumab and 94 did not. The tocilizumab group had less ICU admissions (10.3% vs. 27.6%, P=0.005) and need of invasive ventilation (0 vs 13.8%, P=0.001). In the multivariable analysis, tocilizumab remained as a protective variable (OR: 0.03, CI 95%: 0.007-0.1, P=0.0001) of ICU admission or death. Conclusions. Tocilizumab in early stages of the inflammatory flare could reduce an important number of ICU admissions and mechanical ventilation. The mortality rate of 10.3% among patients receiving tocilizumab appears to be lower than other reports. This is a non-randomized study and the results should be interpreted with caution.
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SciScore for 10.1101/2020.06.05.20113738: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The Institutional Ethics Committee of the Hospital Clínic of Barcelona approved the study and due to the nature of retrospective chart review, waived the need for inform consent from individual patients (Comité Ètic d’Investigació Clínica; HCB/2020/0273).
Consent: The Institutional Ethics Committee of the Hospital Clínic of Barcelona approved the study and due to the nature of retrospective chart review, waived the need for inform consent from individual patients (Comité Ètic d’Investigació Clínica; HCB/2020/0273).Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
… SciScore for 10.1101/2020.06.05.20113738: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The Institutional Ethics Committee of the Hospital Clínic of Barcelona approved the study and due to the nature of retrospective chart review, waived the need for inform consent from individual patients (Comité Ètic d’Investigació Clínica; HCB/2020/0273).
Consent: The Institutional Ethics Committee of the Hospital Clínic of Barcelona approved the study and due to the nature of retrospective chart review, waived the need for inform consent from individual patients (Comité Ètic d’Investigació Clínica; HCB/2020/0273).Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources The analysis was performed in SPSS version 23 (SPSS Inc., Chicago, IL). SPSSsuggested: (SPSS, RRID:SCR_002865)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.Results from TrialIdentifier: We found the following clinical trial numbers in your paper:
Identifier Status Title NCT04310228 Recruiting Favipiravir Combined With Tocilizumab in the Treatment of Co… Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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