RESUMO
INTRODUCTION: No therapy has yet proven effective in COVID-19. Tocilizumab (TCZ) in patients with severe COVID-19 could be an effective treatment. METHOD: We conducted a retrospective case-control study in the Nord Franche-Comté Hospital, France. We compared the outcome of patients treated with TCZ and patients without TCZ considering a combined primary endpoint: death and/or ICU admissions. RESULTS: Patients with TCZ (n=20) had a higher Charlson comorbidity index (5.3 [±2.4] vs 3.4 [±2.6], P=0.014), presented with more severe forms (higher level of oxygen therapy at 13L/min vs 6L/min, P<0.001), and had poorer biological findings (severe lymphopenia: 676/mm3 vs 914/mm3, P=0.037 and higher CRP level: 158mg/L vs 105mg/L, P=0.017) than patients without TCZ (n=25). However, death and/or ICU admissions were higher in patients without TCZ than in the TCZ group (72% vs 25%, P=0.002). CONCLUSION: Despite the small sample size and retrospective nature of the work, this result strongly suggests that TCZ may reduce the number of ICU admissions and/or mortality in patients with severe SARS-CoV-2 pneumonia.
Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Unidades de Terapia Intensiva/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/imunologia , COVID-19 , Estudos de Casos e Controles , Comorbidade , Infecções por Coronavirus/patologia , Estado Terminal/epidemiologia , Estado Terminal/mortalidade , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Pandemias , Pneumonia Viral/patologia , Estudos Retrospectivos , SARS-CoV-2 , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto JovemRESUMO
A NEW DISCIPLINE: On January 4, 1993, the French parliament voted a law on Blood Transfusion Safety, creating a monitoring and warning system operating through a complex network and aimed at guaranteeing permanent efficacy, safety and efficiency of blood transfusion in France. A new discipline, blood monitoring was born. FUNDAMENTAL PRINCIPLES: Basically, blood monitoring is organized around two fundamental principles: blood products trackability from the donor to the recipient and mandatory reporting of all transfusion incidents. After a laborious development phase, the early results point out the immunological risk, particularly by ABO error, and the risk of bacterial contamination. AN EARLY WARNING SYSTEM: This blood monitoring system, whose primary purpose is to serve as an early warning device, must have the necessary tools to monitor, verify and analyze all available epidemiological data. Coordination of the blood monitoring system within the framework of the AFSSaPS (the French Agency for Sanitary Safety of Health Products) should enable it to fully reach this goal.
