ABSTRACT
BackgroundIn some patients the immune response triggered by SARS-CoV-2 is unbalanced, presenting an acute respiratory distress syndrome which in many cases requires intensive care unit (ICU) admission. The limitation of ICU beds has been one of the major burdens in the management worldwide; therefore, clinical strategies to avoid ICU admission are needed. ObjectiveWe aimed to describe the influence of tocilizumab on the need of transfer to ICU or death in non-critically ill patients. MethodsA retrospective study of 171 patients with SARS-CoV-2 infection that did not qualify as requiring transfer to ICU during the first 24h after admission to a conventional ward, were included. The criteria to receive tocilizumab was radiological impairment, oxygen demand or an increasing of inflammatory parameters, however, the ultimate decision was left to the attending physician judgement. The primary outcome was the need of ICU admission or death whichever came first. Results77 patients received tocilizumab and 94 did not. The tocilizumab group had less ICU admissions (10.3% vs. 27.6%, P= 0.005) and need of invasive ventilation (0 vs 13.8%, P=0.001). In multivariable analysis, tocilizumab remained as a protective variable (OR: 0.03, CI 95%: 0.007-0{middle dot}1, P=0.0001) of ICU admission or death. ConclusionTocilizumab in the early stages of the inflammatory flare, could reduce ICU admissions and mechanical ventilation use. The mortality rate of 10.3% among patients receiving tocilizumab appears to be lower than other reports. Clinical implicationOur results suggest that tocilizumab administered to non-critically ill patients could reduce ICU admissions and mortality. Capsule summaryTocilizumab administered to non-critically ill patients with SARS-CoV-2 infection in the early stages of the inflammatory flare, could reduce an important number of ICU admissions and mechanical ventilation use.
