[Evaluation of the Effects of Tocilizumab Use on Oxygen Parameters, Inflammatory Markers and Survival in Patients Diagnosed with COVID-19 in Intensive Care Unit]. / Yogun Bakimda COVID-19 Tanili Hastalarda Tosilizumab Kullaniminin Oksijen Parametreleri, Enflamatuvar Belirteçler ve Sagkalim Üzerine Etkilerinin Degerlendirilmesi.

ABSTRACT

Inflammation plays a key role in the progression of COVID-19 infection from acute viral disease to organ failure and death. Tocilizumab maintains its current place as a frequently preferred agent in hyperinflammatory syndrome in COVID-19 infection. This study was aimed to evaluate changes in oxygen parameters and inflammatory markers before and after treatment, to define survival rates and complications in the patients who have been followed up in the tertiary intensive care unit of our hospital with the diagnosis of COVID-19 and who have been administered tocilizumab for hyperinflammatory syndrome in the follow-up. This study was planned as a retrospective observational study. A total of 132 patients were included in the study. The patient's data; age, comorbidities, sequential organ failure assessment (SOFA) and acute physiologic assessment and chronic health evaluation II (APACHE II) scores, duration of stay on a mechanical ventilator, duration of stay in the intensive care unit, positivity of real-time polymerase chain reaction (Rt-PCR), the presence of lung tomography findings specific to SARS-CoV-2 pneumonia, survival data, laboratory parameters, lactate mmol/L, partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PCO2), oxygen saturation % (SpO2) and partial pressure of oxygen/inspired oxygen (PaO2/FiO2) values on hospitalization date, tocilizumab administration date and post-administration days one, three, five, and seven; treatments administered and drug complications were recorded. IBM SPSS Version 25.0 statistical package program was used for statistical analysis. Of the 132 patients, 36 were female and 96 were male (p= 0.972). The mean age was 61.9 ± 1.07 years, the mean APACHE 2 score ± standard deviation (SD) was 14.89 ± 5.22 and mortality was 41.7%. The mean duration on a mechanical ventilator was 9.54 ± 15.63 days and the mean length of stay in the intensive care unit was 20.50 ± 15.48 days. A statistically significant difference was found between the PaO2, SpO2, and the PaO2/FiO2 values on the day of hospitalization and days one, three, five, and seven after tocilizumab administration, and also between the day of tocilizumab administration and days following the administration (p<0.001). There was a significant decrease in ferritin, D-dimer, and C-reactive protein levels, and a significant increase in the lymphocyte count (p<0.05). Elevated transaminases (n= 36), acute renal injury (n= 25), atrial fibrillation (n= 10), pneumothorax (n= 10), and pneumomediastinum (n= 6) were the most common complications during the disease. In our study, a significant improvement was observed in inflammatory parameters and oxygen parameters from the first day after tocilizumab administration. In the first seven days patient mortality was zero with improvement in the P/F ratios. These data supported the opinion that tocilizumab might be an effective treatment option for COVID-19 infection. In addition to the potential benefits of tocilizumab in critical COVID-19 patients, it is essential that the side effects related to the use of the drug be closely monitored, and early identification of and intervention in thromboembolic events increases survival.