ABSTRACT
OBJECTIVE: This retrospective study aims to investigate the impact of tocilizumab on inflammatory markers in patients with severe COVID-19. The effect on oxygenation was also assessed. METHODS: This study is a single-centre, retrospective cohort study conducted at NIMS hospital. Data of the eligible patients with severe COVID-19 pneumonia who received injection tocilizumab (max 800 mg) were charted and analysed. Oxygenation and inflammatory markers were compared before and after (day 3 and day 7) tocilizumab injection. Effect of dysglycemia on the efficacy of tocilizumab was assessed. Outcomes were analysed in the form of discharge without oxygen, discharge with oxygen, and death. Data were analysed by SPSS v22. RESULTS: The mean age of the subjects was 57.8 ± 12.2 years, and 78.57% were male. Forty-four percent of the patient had type 2 diabetes. Tocilizumab treatment was associated with reduction in the oxygen requirement [median:10 L/min (IQR6- 14)] v/s 4 L/min (IQR 3-7, p-0.005]. Peripheral oxygen saturation also improved after tocilizumab [92 % (IQR 90-96)] v/s [95 % (IQR 94-96), p-0.01)], respectively. Serum CRP level decreased significantly when evaluated after three days (44±5 v/s 20 ±3 mg/dl, p=< 0.001). Out of the 42, 12 (29%) patients died due to severe COVID-19 or its complications. When compared with the patients who survived, patients who died had a higher level of D-dimer (1.2 ± 0.51 v/s 3.1 ±1.2 ng/dl, p-value- 0.04), and LDH: (845 ±55 v/s 1364 ±198 U/L, p - 0.01). At day seven of the tocilizumab injection, diabetic patients (n-13) had higher IL-6 serum level than nondiabetic patients (n-16) [(median- 311(IQR-1245.5) v/s (209 (IQR-546.2), p-value- 0.048]. CONCLUSION: In this retrospective pre-post analysis, tocilizumab injection was associated with reduced inflammation and improved oxygenation in severe COVID-19. Despite high IL-6 levels, diabetes had no impact on the efficacy of the tocilizumab.
Subject(s)
COVID-19 Drug Treatment , Diabetes Mellitus, Type 2 , Aged , Antibodies, Monoclonal, Humanized , Biomarkers , Diabetes Mellitus, Type 2/drug therapy , Female , Humans , Interleukin-6 , Male , Middle Aged , Oxygen , Retrospective Studies , SARS-CoV-2ABSTRACT
PURPOSE: To assess the prevalence of post-COVID symptoms in patients with recovered COVID-19 (nasopharyngeal RT PCR negative) who were discharged from an acute COVID care facility at a tertiary care teaching hospital in North India. METHODS: This study was an observational study with retrospective data collection, conducted in the COVID follow-up clinic, a combined clinic of medicine and endocrinology. Patients discharged from the acute COVID care facility were recruited after 14 days of discharge if they fulfilled inclusion and exclusion criteria. The retrospective data was collected from the hospital records/EMR and analysed by the SPSSv23. RESULTS: Fifty patients, who fulfilled the inclusion and exclusion criteria, were included in the study. The Mean age of patients was 53.4±13.8 years (range 28-77). Seventy six percent were male, and 38% had type 2 diabetes. Fever (94%), cough (78%) and breathlessness (68%), were the most common symptoms at presentation to acute care facility. Oxygen saturation at presentation had a negative correlation with D-Dimer, age, and C reactive protein. When patients were evaluated clinically, after 14 days (range 15 to 50 days) of the discharge, 82% of patients had at least one persistent symptom. Fatigue (74%) was the most common symptoms in follow-up followed by breathlessness (44%), and muscle weakness (36%). Two patients had persistent fever, even after negative RT PCR status. CONCLUSION: Patients discharged from the acute COVID care facility had a high prevalence of post-COVID symptoms even after 14 days.