ABSTRACT
Background: Clinical studies have correlated severe deterioration of COVID-19 patients due to excessive and uncontrolled production of cytokines. There is a pressing need to explore therapies, which could prevent the cytokine storm rather than terminating it. Aims and objectives: The aim of the study is to evaluate the effect of itolizumab on clinical outcomes of patients with moderate-severe COVID-19 disease admitted to ICU. The primary aim of the current study is to find out any mortality benefit in 14 days. The secondary aim is to assess the morbidity outcomes in terms of reduction in inflammatory markers and also the duration of hospital stays to assess the prognostication. Materials and methods: It is a retrospective case-control study in which laboratory-confirmed COVID-19 patients admitted to ICU were taken. A total of 62 patients were recruited, 31 patients received itolizumab (cases/treatment group) and 31 patients didn't receive itolizumab (designated as controls). Results: Among the total patients recruited, 68% of the study population was male and 32% were female. A total of 12 patients expired among cases and 13 expired among controls. Overall mortality in both groups was noted to be almost similar. The control group showed mortality at lower computed tomography (CT) scores compared to the cases. There is a significant reduction in inflammatory markers, like interleukins-6 (IL-6) and D-dimer in cases compared to the control group. Conclusion: In conclusion, treating patients with cytokine storms before they require intubation/mechanical ventilation is crucial to preventing deaths. Itolizumab has shown no clinical benefit in critically ill COVID-19 patients, however, timely initiation of itolizumab therapy may serve as a key therapeutic option in preventing the mortality and morbidity outcomes in moderate-severe COVID-19 patients. © The Author(s). 2022Open Access This article is distributedunder the terms ofthe Creative Commons Attribution 4.0InternationalLicense (https://creativecommons.org/licenses/by-nc/4.0/)
ABSTRACT
Background: Since the COVID-19 global pandemic emerged, the worldwide medical fraternity has been facing multiple challenges regarding its management. Patients with severe/critical illness have a poor prognosis. Hence, early detection and assessment of disease severity is vital to offer timely management. Recent studies indicate that altered haematological parameters may predict the disease severity and mortality. We aimed to investigate associations between haematological parameters and disease severity in patients with SARS CoV 2 infection. Objectives: This study was undertaken to find out the optimal cut-off values of haematological parameters that may significantly relate to the clinical severity of COVID-19 and to evaluate their utility as parameters to predict mortality. Methods: It was a hospital based prospective cohort study, conducted over a period of 4 months, fromMay, 2020 to August, 2020 at a level 3 designated COVID-19 facility in Uttar Pradesh. In our cohort, there were a total of 211 patients out of which 125 were non-ICU admissions and 86 were ICU admissions. Cases were classified as severe, moderate andmild based on their oxygen requirements and ICU care needs. Results: The mean age of non-ICU patients was 47.1 ± 16.2 years, ICU survivors, were aged 57.4 ± 11.4, and ICU non-survivors were aged 57.3 ± 15.2. There was no mortality in the non-ICU group. Of the 86 ICU admissions, 69 were male, of which 27 were non-survivors and 17 were female, of whom 5 were non-survivors. Amongst the deceased patients, there was a significant leucocytosis (P < 0.001), neutrophilia (P < 0.001) and increased NLR (P = 0.026). The pooled analysis revealed that the NLR cut-off of > 3.85 was associated with severity and prediction for ICU admission, while NLR of > 5.2857 was associated with mortality. Conclusion: In conclusion, advanced age, male sex, a high white blood cell count, neutrophilic leucocytosis or neutrophilia along with the elevated NLR were significantly associated with both the clinical severity and mortality. © 2021, Indian Academy of Clinical Medicine. All rights reserved.