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ABSTRACT BACKGROUND: Coronavirus disease 2019 (COVID-19) can cause cytokine release syndrome (CRS), which leads to high mortality rates. Tocilizumab suppresses CRS by blocking the signal transduction of interleukin-6 (IL-6). OBJECTIVE: To evaluate the clinical and laboratory parameters associated with mortality among patients receiving tocilizumab treatment. DESIGN AND SETTING: Retrospective observational study conducted in the chest disease departments of two different training and research hospitals in the center of Ankara, Turkey. METHODS: Patients who were hospitalized and treated with tocilizumab in September 2020 were retrospectively analyzed. Their laboratory parameters and clinical characteristics were obtained from the hospital information system database. Comparative analyses were performed between the patients who died and the ones who survived. RESULTS: A total of 58 patients who received tocilizumab treatment were included in this study, among whom 35 (60.3%) died. There was no difference between the mortality and survival groups in terms of white blood cell (WBC), neutrophil, lymphocyte, ferritin or C-reactive protein (CRP) levels detected on admission. WBC, lymphocyte, neutrophil and CRP levels measured on the third and fifth days after tocilizumab administration were found to be significantly lower in the survival group (P < 0.05). In multiple logistic regression analysis, age and oxygen saturation were determined to be independent risk factors for mortality. CONCLUSION: Persistently high WBC, CRP and neutrophil levels and low lymphocyte levels could be considered to be valuable indicators of mortality among COVID-19 patients treated with tocilizumab. Age and low oxygen saturation are independent risk factors for mortality among patients receiving tocilizumab treatment.
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Diabetes mellitus (DM) has been shown to be an independent risk factor for developing the severe form of COVID-19, which in most cases requires management in intensive care units with mechanical ventilation and is associated with increased mortality. Objective Review and analyze the available scientific literature on COVID-19 in patients with Diabetes Mellitus Methods A search and analysis of the scientific literature was carried out in Pubmed, including publications in Spanish, English and French that deal directly with the topic diabetes mellitus and COVID-19. Results and Conclusions Adequate glycemic control has been shown to decrease mortality both in patients with previous diabetes and in those who develop hyperglycemia during hospitalization for COVID-19. For patients with diabetes mellitus that should be evaluated in an outpatient setting, telemedicine strategies are effective and should encompass nutritional management, adherence to treatment, and pharmacological aspects. Management with insulin therapy is the treatment of choice for hospitalized patients with moderate or severe COVID-19.
La diabetes mellitus (DM) ha demostrado ser un factor de riesgo independiente para desarrollar COVID-19 grave, la mayoría de estos casos requiere manejo en unidades de cuidado intensivo y se asocia a mayor mortalidad y costos sanitarios. Objetivo Realizar una búsqueda y análisis de la literatura científica disponible sobre COVID-19 en pacientes con Diabetes Mellitus. Métodos Se realizó una búsqueda sistemática y análisis de la literatura científica en Medline a través de PubMed, incluyendo publicaciones en español, inglés y francés que incluyan los siguientes términos de búsqueda: diabetes mellitus y COVID-19. Resultados y conclusiones Se ha demostrado que la hiperglucemia es un factor predictor para COVID-19 grave y se asocia a un incremento de mortalidad, así también se describe que un adecuado control glucémico disminuye la mortalidad tanto en pacientes con diabetes previa, como en aquellos que desarrollan hiperglucemia durante la hospitalización por COVID-19. El manejo con insulinoterapia es el tratamiento de elección para pacientes hospitalizados con COVID-19 moderada o severa. Para pacientes con diabetes mellitus que deben ser evaluados en un escenario ambulatorio, las estrategias de telemedicina son eficaces y deben abarcar el manejo nutricional, apego al tratamiento y aspectos farmacológicos