Similar pulmonary functional outcomes at 3 months in critical COVID-19 survivors hospitalized during the first, second, and third pandemic waves (preprint)

Introduction: Despite improvements in the management of COVID-19 patients, we still don’t know whether pharmacological treatments and improvements in ventilatory support have changed outcomes for intensive care unit (ICU) survivors of the three consecutive waves (w) of the pandemic. The objective of this study was to assess pulmonary functional outcomes, radiologic pattern, and quality of life (QoL) in ICU COVID-19 survivors at 3 months, according to pandemic wave. Methods All patients admitted to the ICU for COVID-19 acute respiratory distress syndrome (ARDS) at two university hospitals were prospectively included and assessed 3 months post-ICU discharge by chest CT, pulmonary function test (PFT), 6-minute walking distance test (6MWDT), respiratory muscle strength (RMS) test, and Short Form 36 (SF-36) questionnaire. Results Eighty-four ARDS COVID-19 survivors were included. Hospital length of stay was shorter during w3 vs w1 (23.4 ± 14.2 days vs 34.7 ± 20.8 days, p = 0.03). Fewer patients required mechanical ventilation (MV) during w2 vs w1 (33.3% vs 63.9%, p = 0.0038). Three months after ICU discharge, PFT, 6MWDT, and RMS were similar, regardless of wave (p > 0.05). QoL (SF-36) was worse for patients in w1 vs w3 (64.7 ± 16.3 vs 49.2 ± 23.2, p = 0.0169). On linear/logistic regression analysis, MV was associated with decreased TLC, FEV1, DLCO, and RMS (w1,2,3, p 

Tocilizumab-induced unexpected increase of several inflammatory cytokines in critically ill COVID-19 patients (preprint)

Early evidence during the COVID-19 pandemic indicated high levels of IL-6 in patients with severe COVID-19. This led to the off-label use of tocilizumab (TCZ) during the first wave of the pandemic.We aimed to monitor IL-6 and several inflammatory cytokines in critically ill COVID-19 patients receiving off-label TCZ. Fifteen critically ill SARS-CoV-2 PCR confirmed cases were enrolled and serum samples were collected during 8 days, before and following administration of a single dose of TCZ. In parallel, a control group consisting of 8 non-treated COVID-19 patients not receiving TCZ was established. Serum profile of 12 cytokines (IL-1β, -2, -4, -6, -8, -10, -12, -13, -17, -18, TNF-α and INF-γ) and of IL-6R were assessed in these two groups. Although the increased IL-6 concentrations after TCZ infusion were expected, we observed an unexpected increase in IL-1β, -2, -4, -10, -12p70, -18 and IL-6R levels in the treated patients with maximal values reached 2 to 4 days after TCZ. In contrast, no change in cytokine levels was observed in the control group. There was no significant difference in cytokine levels between survivors (TCZ/S) or non-survivors (TCZ/D). This observation suggests that some inflammatory pathways escape IL-6R blockade leading to an increase in several pro-inflammatory cytokines. Our findings could highlight an anti-inflammatory role of IL-6 and may explain why TCZ has failed to improve survival in critically ill COVID-19 patients when given alone.

Determination of the Hemoadsorption Impact as Adjunctive Treatment Upon the Support Therapy of COVID-19