ABSTRACT
Introduction: Anemia of inflammation is considered to be a main cause of anemia on the ICU. Inflammatory cytokines, most importantly IL-6, play a role in this pathogenesis. Given that both anemia and red blood cell (RBC) transfusions are associated with adverse outcomes, and iron is ineffective, novel treatments of anemia are wanted. The aim of this study is to investigate the effect of immunosuppressive agents on anemia development and RBC transfusions in critically ill COVID patients. Method(s): This retrospective cohort study included all ICU patients of two hospitals in the Netherlands between February 2020 and April 2022 with a PCR-positive COVID-19 ARDS. Actively bleeding patients were excluded. Evolving insights in the treatment protocol resulted in three treatment groups: no treatment, steroids or combination of steroids with tocilizumab. Daily lab results and number of RBC transfusion were retrieved and the decline in Hb level between ICU admission day 1 and 7 was calculated. A multiple linear regression analysis was used to compare outcomes. Result(s): In total, 719 patients were included, of which 168 in the no-treatment group, 337 in the steroid group and 212 in the steroids and tocilizumab group. Hb levels declined in all groups. The median decline in Hb level in the combination group was lowest, with -0.3 mmol/l [-0.9 to 0.2], -0.8 mmol/l [-1.3 to -0.1] in the group receiving steroids in the steroid group and [-1.6 to -0.5] in the no treatment group. The number of RBC transfusions was 1 [1-3] in the group receiving combination therapy, 3[1-6] in the group receiving steroids and 3[2-8] in the group receiving no treatment (p < 0.002). In a multivariate analysis, the receipt of combination therapy remained associated with inhibition of decline in Hb as well as with lowering the number of RBC transfusions. Conclusion(s): Treatment with either steroids or a combination of steroids and tocilizumab was associated with a slower decline in Hb levels during ICU stay and less RBC transfusions when compared to no treatment.