Cytokine storm in severe COVID-19: Does remdesivir/ tocilizumab improve clinical outcome?

ABSTRACT

Objective: To study correlation of age, gender, serum IL-6 & D-dimer value (on admission), and impact of Tocilizumab (immunomodulator)/ Remdesivir (antiviral) therapy on clinical outcome (28-day mortality), in severe COVID-19. Methodology: Confirmed cases of severe COVID-19 (ICMR/ WHO criteria), admitted in the COVID-ICU were included. Venous plasma samples were collected within 6 hours of admission on day 1 for measurement of IL-6 and Ddimer and analyzed within 2 hours. Demographic characteristics, laboratory tests and therapeutic interventions were recorded. Results: The incidence of death was significantly higher in males above fifty years. The mortality rate correlated with increasing values of IL-6 (highest at levels >70 pg/mL. D-dimer values above 0.5μg FEU/mL were associated with increased risk of poor outcome. 85.3% of patients treated with Remdesivir showed clinical improvement. When Tocilizumab and Remdisivir were administered together, 44.0% of patients survived while 56% expired. Conclusion: Men above fifty years were most vulnerable to a poor outcome. Higher levels of IL-6 and D-dimer correlated with increased mortality. Both these biomarkers may be estimated on admission, and serially thereafter, to guide clinicians in recognizing patients with severe COVID-19 early in the disease course, and monitor prognosis. Remdesivir improved clinical outcome. The mortality rate was higher when Remdesivir and Tocilizumab were administered together.