Résumé
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has created severe medical and economic consequences worldwide since 2019. Tocilizumab is one of the therapies considered capable of improving the condition of patients with COVID-19. However, there is not much information about the best time to give tocilizumab. METHOD(S): This was an analytical study with a retrospective cohort design, using the data of 125 patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with signs of acute respiratory distress syndrome in Dr. Moewardi Hospital, Surakarta, from March to August 2020. We analyzed various available clinical data to see which factors into clinical improvement with tocilizumab therapy. RESULT(S): Most patients showed clinical improvement after administration of tocilizumab. During the follow-up period, 21 patients died despite tocilizumab therapy. Significant risk factors associated with the need for intubation were heart rate, neutrophil, lymphocyte, pH, PaCO2, and PO2. The most influential variable on the need for intubation without being associated with other risk factors was PaO2 (p = 0.003, Confidence Intervals 95%). CONCLUSION(S): Tocilizumab has a role in treating patients infected by SARS-CoV-2, preventing the need for intubation when given to patients in good saturation condition with oxygen supplementation without positive pressure (PaO2 >65mmHg;SpO2 >93%).Copyright © 2023 Septian Adi Permana, Adhrie Sugiarto, Sidharta Kusuma Manggala, Muhammad Husni Thamrin, Purwoko Purwoko, Handayu Ganitafuri.
Résumé
Background: The case fatality rate (CFR) of COVID-19 was 8.7% in Indonesia on April 2020. Simplified Acute Physiology Score 3 (SAPS 3) has been used to predict the hospital mortality based on different variables including acute physiologic derangements, current conditions and interventions, and previous health status assess the severity of condition during the first hour of admission to the ICU. We assessed SAPS 3 to predict the outcome and mortality of critical COVID-19 patients in ICU over a period of 28 days. Methodology: This retrospective cohort study consisted of adult patients admitted to ICU with probable or confirmed COVID-19 in our hospital. We recorded the patients SAPS 3 score from the medical record as well as the 28-day mortality. Validity of the SAPS 3 score was done by the Area Under Curve (AUC) measurement and Hosmer-Lemeshow calibration test. Result(s): The mortality rate of critical COVID-19 patients was 43.8%. The age, intra-hospital location before ICU admission, use of vasoactive drugs (P < 0.0001), focal neurological deficits (P < 0.0001), respiratory failure (P = 0.004), creatinine >= 3.5 mg/dL (P = 0.005), and platelets < 50,000 /microL (P = 0.032) were significantly associated with 28-days mortality in the ICU. SAPS 3 showed good discrimination and predictability. The optimal cut-off point was 39 with 70.3% sensitivity and 74.4% specificity. Conclusion(s): SAPS3 score system was valid in predicting the 28-day mortality of COVID-19 patients in the ICU with good discrimination and calibration value;therefore, it is an important predictor tool for early prognosis screening that will help reduce the strain over the ICU resources. Abbreviations: CFR: Case Fatality Rate;SAPS 3: Simplified Acute Physiology Score 3;COVID-19: The Coronavirus Disease 2019;ICU: Intensive Care Unit;APACHE: Acute Physiology and Chronic Health Evaluation;SPSS: Statistical Package for Social Sciences;GCS: Glasgow Coma Scale;ROC: Receiver Operating Characteristic;PHEIC: Public Health Emergency of International Concern;OR: Odds Ratio Copyright © 2022 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.