Tocilizumab treatment for SARS-CoV2 pneumonia:when and where?

Background and Aim of the study: Intravenous administration ofTocilizumab (TCZ), a monoclonal antibody against interleukin-6(IL-6) receptor, has been proven to be an effective treatment forSars-COV2-associated pneumonia. In our observationalretrospective study we compared different outcomes measures inpatients with different settings and timing of treatment.Materials and Methods: We included patients affected bynasopharyngeal swab-confirmed SARS COV-2 pneumonia whoreceived TCZ treatment admitted to the COVID Unit of F. MiulliHospital (BA), from 16th March to 7th April 2020. Outcomemeasures were pO2/FiO2 ratio (P/F) and CRP serum levels atbaseline and at 6,24 and 48 hours after intravenous administrationof TCZ. We compared patients treated in intensive care unit (ICP)and non-intensive unit (NICP) even with respect to the duration ofthe disease, shorter (SD) or longer (LD) than 16 days.Results: We analyzed 16 patients;mean disease duration 15±5days. At baseline, mean CRP was 14±10 mg/dl and P/F 144±44mmHg. 6 hours after TCZ P/F improved significantly in NICP(p=0.03) but not in ICP, confirmed at 48h (NICP p=0.002, ICPp=0.23). Comparison between SD and LD showed that P/F earlyimproved(24h) only in SD (p=0.03). At 48 h, P/F improved in bothgroups (SD p=0.05, LD p=0.03). CRP decreased both in ICP(p=0.01) and NICP (p=0.04);in regard of timing, only in SDpatients (p=0.002) it decreased significantly.Conclusions: Our real-life experience suggests that TCZadministration is effective when early performed in subjectsadmitted to non-intensive therapy.

Laboratory characteristics of patients affectedby SARS-CoV2 pneumonia after tocilizumab treatment

Background and Aim of the study: Tocilizumab (TCZ), an IL-6 receptor (IL-6R) blocker, emerged as an effective drug for patientswith severe COVID-19 associated Pneumonia. The aim of this observational retrospective study was to evaluate the laboratory characteristics of patients who received i.v. TCZ treatment. Materials and Methods: We collected serum levels of IL-6, procalcitonin (PCT), C-reactive protein(CRP), D-Dimers and CD4/CD8ratio, to evaluate the systemic inflammatory state, of 16 patientsaffected by nasopharyngeal swab confirmed SARS COV-2 Pneumonia who received TCZ (8 mg/kg once or twice in 12 hours).Blood samples for analysis were collected before and after theadministration.Results: Baseline serum levels of laboratory parameters were:CRP 14±10 mg/dl,IL-6 249±264 pg/dl, D-dimers 1872±1833pg/ml, CD4/CD8 ratio 2,4±1,2, PCT 0,61±0,91 pg/ml. After TCZadministrations we observed a rapid increase of IL-6 serum levelsto 941±1317 pg/dl (p=0,05), CD4/CD8 ratio to 3,1±2,3 (trendp=0,07) while D-Dimers didn't decrease significantly. CRP levels,after the administration, decreased to 6±6 mg/dL(p=0,0002)while PCT levels showed no significant variations.Conclusions: The anti-inflammatory effect of TCZ administrationis suggested by the variations in laboratory characteristic, most ofall represented by a decrease of CRP levels and an increase of IL-6 levels, as a result of the displacement of the interleukin from itsreceptor.

Tocilizumab treatment for SARS-CoV2 Pneumonia:report of a single centre real-life experience

Background and Aim of the study: Tocilizumab (TCZ), a monoclonal antibody against IL-6 receptor, has been recently employedas a treatment for SARS-Cov2-associated pneumonia (COVID),due to the central role of IL-6 on the citokyne-storm associatedhyperinflammatory syndrome. Aim of this observational retrospective study was to evaluate effectiveness and safety of TCZ for thetreatment of COVID.Materials and Methods: We retrospectively evaluated, from 16thMarch 2020 to 7th April 2020, outcomes of 16 patients affected bynasopharyngeal swab-confirmed SARS-COV-2 Pneumonia who received TCZ i.v. treatment (8 mg/kg once or twice in 12 hours). Weevaluated clinical features, Arterial Blood Gas Test (ABG), laboratoryfindings collected at baseline and after consecutive two days. Results: We analyzed 16 patients (M/F: 12/4) with mean age (±SD) 69±9 years and mean disease duration 15±5 days. At baseline, mean CRP level was 14±10 mg/dl and IL-6 249±264 pg/ml.To evaluate respiratory improvement after treatment, we collectedABG data at 6,24 and 48 hours;we observed a rapid improvement of P/F ratio to 165,6±55,4 mmHg (p=0,01). We also observed a significant reduction of CRP levels to 6±6 mg/dl(p=0,0002) and a rapid increase of IL-6 serum levels to941±1317 pg/ml (p=0,05). Clinically we observed a global improvement in ten patients, while six died for infective complications. No adverse event was detected following TCZ administration.Conclusions: In our real-life experience TCZ treatment was effective and safe in a group of patients affected by SARS COV2-associated pneumonia.

Radiological features of SARS-CoV2 associated pneumoniain a cohort of patients admitted in COVID Unit

Background and Aim of the study: A novel coronavirus (SARSCoV2) in 2019 has been recognized as the responsible of an interstitial pneumonia characterized by a severe acute respiratorysyndrome initially reported in China with a subsequent pandemicoutbreak. Aim of this observational retrospective cohort study wasto describe the CT findings of this new disease in a cohort of patients treated in our COVID Unit.Materials and Methods: TC scan of 49 patients with naso-pharyngeal swab confirmed SARS CoV2 pneumonia admitted toCOVID Unit of F. Miulli General Hospital from 19th March 2020 to03rd May 2020 were retrospectively analyzed.Results: The cohort included 49 patients (42 males, 86%;7 female, 14%);mean age 63,2 years (SD 14,8). Radiological findings distribution was bilateral in the whole cohort;peripheralinvolvement was constant (n=46 [93%]), in some cases exclusively subpleural (n=10;20%), with pleuric sparing in few cases(n=7, 14%). 2 patients had central distribution of alterations (4%).The great part of the cohort showed mixed (central/periferic) distribution (n=29 [60%]). Radiological phenotypes were: predominant ground-glass (GG) (n=20 [41%]), consolidative (C) (n=3,6%) and mixed pattern (n=23, 47%).Conclusions: SARS-CoV2 is characterized by a wide range of CTfeatures with a frequently mixed presence of ground glass and consolidative with a periferic and central - usually bilateral - distribution. Combining assessment of imaging with clinical and laboratory findings could facilitate early diagnosis of COVID-19.

SARS-CoV2 in a population over 75 years old:differences with young people

Background and Aim of the study: As of 17 June 2020, Italy had237.828 cases of SARS-CoV-2 infections, with about 35.000deaths;median age of cases 61 years, median age of deceased81 years. A single-center observational cohort study was conducted to evaluate clinical features, laboratory characteristicscomparing two groups of subjects by age (>75 and <75 years)admitted in the sub-intensive therapy of the COVID Unit HospitalF. Miulli (Acquaviva delle Fonti, Bari, Italy) from 17 march to 17may 2020.Materials and Methods: The data contained in the medicalrecords were studied.Results: A total of 174 patients hospitalized (60.4% males),mean age 68 yrs, with diagnosis of SARS-CoV2, were analyzed;they were divided into two groups >75 years and <75 years (110pts and 64 pts respectively). The group of older subjects had ahigher prevalence of comorbility (heart, kidney failure, COPD);mortality was more significant in subjects >75 years (37.3% vs 0.9%)compared to young people. No difference was observed in thelength of stay (21 days on average), while the younger subjectswere treated with hydroxychloroquine more than the elderly(83.6% vs 40.6% respectively) as well as with lopinavir / ritonavir(39.4% vs 14.5%).Conclusions: Our data, although referring to a small sample ofsubjects, show that patients over 75 years of age are more fragile(die more), have better comorbidities and have been under treatedcompared to younger subjects.

Clinical presentation and management of patients withSevere Acute Respiratory Syndrome Coronavirus 2 Infectionin a Sub-intensive COVID Unit of South-Italy

Background and Aim: As of 22 June 2020, Italy had 238.499cases of Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2) infections, with about 35.000 deaths. A single-center observational cohort study was conducted to evaluate epidemiological, demographic, clinical and laboratory data of SARS-CoV-2patients who were admitted to the sub-intensive therapy unit ofthe COVID Unit Hospital F. Miulli (Acquaviva delle Fonti, Bari, Italy),from Mar 17, 2020 to May 17, 2020.Materials and Methods: Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes wereall collected and analysed. Results: A total of 143 SARS-CoV-2 patients, 60.4% males, meanage 68 yrs , were included. Twenty-seven patients (19%) had clinical signs of severe pneumonia and 6.3% had an ARDS, ICU admissions were 2.9%. The most represented comorbidities were:chronic heart failure (10.3%), diabetes (15.5%), chronic obstructive pulmonary disease (17.8%), cancer (13.2%), kidney chronicfailure (28.2%). The used drugs have been distributed as follows:lopinavir/ritonavir (30.4%), hydroxychloroquine (67.8%), steroid(21.2%), tocilizumab (4%). Length of stay was 21 days and theaverage negative time of the second nasopharyngeal swab was18 days. In our study, a total of 20 patients (13.9%) died, withmean age 86 yrs .Conclusions: Our findings show that SARS-CoV-2 infection maybe severe, requiring intensive care admission, expecially in olderpatients and in those with comorbidities.

Clinical features of a cohort of patients with CoronavirusDisease 2019 and severe respiratory failure treated withC-PAP support

Background and Aim of the study: From March 2020 to May2020 we treated 133 SARS-CoV-2 patients in our COVID Unit at'F. Miulli' Hospital, 15 of these were also affected by severe acuterespiratory syndrome that needed CPAP support. The aim of thestudy was to evaluate the clinical features of patients with severerespiratory failure treated with CPAP compared to those with milderone that didn't require it.Materials and Methods: A retrospective observational study on133 patients was performed. Patients have been divided into twogroups: those who needed CPAP (15) and those who didn't (118)to compare comorbidities and the supportive medical therapy.Results: 80% of the patients treated with CPAP were males (age71 ± 12). Only 13% were smokers;the most frequent comorbidities were heart failure (20%) and renal failure (40%);pre-existentrespiratory diseases, high blood pressure and diabetes mellitusdidn't show a significant impact on the respiratory outcome. Comparing the 2 groups we found a significant difference about theprobability to be transferred in Intensive Care Unit, higher in CPAPtreated patients (p 0,034). We also found differences between thetwo groups about the medical therapy support, in particular theuse of diuretics, resulted significantly higher (p 0,002) in CPAPtreated patients.Conclusions: A severe respiratory failure related to COVID 19 ap pears to be more frequently associated with kidney and heart disease rather than pre-existing worst respiratory situation and so requires in association with C-PAP support also a more substantialmedical therapy.