RT Journal Article
T1 The Use of Corticosteroids or Tocilizumab in COVID-19 Based on Inflammatory Markers.
A1 Rubio-Rivas, Manuel
A1 Mora-Luján, José M
A1 Montero, Abelardo
A1 Aguilar García, Josefa Andrea
A1 Méndez Bailón, Manuel
A1 Fernández Cruz, Ana
A1 Oriol, Isabel
A1 Teigell-Muñoz, Francisco-Javier
A1 Dendariena Borque, Beatriz
A1 De la Peña Fernández, Andrés
A1 Fernández González, Raquel
A1 Gil Sánchez, Ricardo
A1 Fernández Fernández, Javier
A1 Catalán, Marta
A1 Cortés-Rodríguez, Begoña
A1 Mella Pérez, Carmen
A1 Montero Rivas, Lorena
A1 Suárez Fuentetaja, Rebeca
A1 Ternero Vega, Jara Eloísa
A1 Ena, Javier
A1 Martin-Urda Díez-Canseco, Anabel
A1 Pérez García, Cristina
A1 Varona, José F
A1 Casas-Rojo, José Manuel
A1 Millán Núñez-Cortés, Jesús
A1 SEMI-COVID-19 Network, 
K1 COVID-19
K1 corticosteroids
K1 mortality
K1 tocilizumab
K1 treatment
AB The inflammatory cascade is the main cause of death in COVID-19 patients. Corticosteroids (CS) and tocilizumab (TCZ) are available to treat this escalation but which patients to administer it remains undefined. We aimed to evaluate the efficacy of immunosuppressive/anti-inflammatory therapy in COVID-19, based on the degree of inflammation. A retrospective cohort study with data on patients collected and followed up from March 1st, 2020, to May 1st, 2021, from the nationwide Spanish SEMI-COVID-19 Registry. Patients under treatment with CS vs. those under CS plus TCZ were compared. Effectiveness was explored in 3 risk categories (low, intermediate, high) based on lymphocyte count, C-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, and D-dimer values. A total of 21,962 patients were included in the Registry by May 2021. Of these, 5940 met the inclusion criteria for the present study (5332 were treated with CS and 608 with CS plus TCZ). The primary outcome of the study was in-hospital mortality. Secondary outcomes were the composite variable of in-hospital mortality, requirement for high-flow nasal cannula (HFNC), non-invasive mechanical ventilation (NIMV), invasive mechanical ventilation (IMV), or intensive care unit (ICU) admission. A total of 5940 met the inclusion criteria for the present study (5332 were treated with CS and 608 with CS plus TCZ). No significant differences were observed in either the low/intermediate-risk category (1.5% vs. 7.4%, p=0.175) or the high-risk category (23.1% vs. 20%, p=0.223) after propensity score matching. A statistically significant lower mortality was observed in the very high-risk category (31.9% vs. 23.9%, p=0.049). The prescription of CS alone or in combination with TCZ should be based on the degrees of inflammation and reserve the CS plus TCZ combination for patients at high and especially very high risk.
YR 2021
FD 2021-10-18
LK http://hdl.handle.net/10668/20830
UL http://hdl.handle.net/10668/20830
LA en
DS RISalud
RD Apr 8, 2025