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Article

Efficacy of Tocilizumab Therapy in Different Subtypes of COVID-19 Cytokine Storm Syndrome

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Department of Anaesthesiology and Intensive Care, Bogomolets National Medical University, 01601 Kyiv, Ukraine
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Department of Emergency Medicine, Pope John II State School of Higher Education in Biala Podlaska, 21-500 Biala Podlaska, Poland
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Department of Internal Medicine, Pneumonology and Allergology, Wroclaw Medical University, 50-367 Wroclaw, Poland
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Department of Immunology and Allergology, Bogomolets National Medical University, 01601 Kyiv, Ukraine
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Department of Medical Statistics, Bogomolets National Medical University, 01601 Kyiv, Ukraine
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Department of Forensic Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland
*
Author to whom correspondence should be addressed.
Academic Editor: Luis Martinez-Sobrido
Viruses 2021, 13(6), 1067; https://doi.org/10.3390/v13061067
Received: 20 April 2021 / Revised: 13 May 2021 / Accepted: 30 May 2021 / Published: 3 June 2021
(This article belongs to the Section SARS-CoV-2 and COVID-19)
Background: Cytokine storm in COVID-19 is heterogenous. There are at least three subtypes: cytokine release syndrome (CRS), macrophage activation syndrome (MAS), and sepsis. Methods: A retrospective study comprising 276 patients with SARS-CoV-2 pneumonia. All patients were tested for ferritin, interleukin-6, D-Dimer, fibrinogen, calcitonin, and C-reactive protein. According to the diagnostic criteria, three groups of patients with different subtypes of cytokine storm syndrome were identified: MAS, CRS or sepsis. In the MAS and CRS groups, treatment results were assessed depending on whether or not tocilizumab was used. Results: MAS was diagnosed in 9.1% of the patients examined, CRS in 81.8%, and sepsis in 9.1%. Median serum ferritin in patients with MAS was significantly higher (5894 vs. 984 vs. 957 ng/mL, p < 0.001) than in those with CRS or sepsis. Hypofibrinogenemia and pancytopenia were also observed in MAS patients. In CRS patients, a higher mortality rate was observed among those who received tocilizumab, 21 vs. 10 patients (p = 0.043), RR = 2.1 (95% CI 1.0–4.3). In MAS patients, tocilizumab decreased the mortality, 13 vs. 6 patients (p = 0.013), RR = 0.50 (95% CI 0.25–0.99). Conclusions: Tocilizumab therapy in patients with COVID-19 and CRS was associated with increased mortality, while in MAS patients, it contributed to reduced mortality. View Full-Text
Keywords: monoclonal antibodies; ARDS; cytokine storm syndrome; inflammation monoclonal antibodies; ARDS; cytokine storm syndrome; inflammation
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MDPI and ACS Style

Oliynyk, O.; Barg, W.; Slifirczyk, A.; Oliynyk, Y.; Gurianov, V.; Rorat, M. Efficacy of Tocilizumab Therapy in Different Subtypes of COVID-19 Cytokine Storm Syndrome. Viruses 2021, 13, 1067. https://doi.org/10.3390/v13061067

AMA Style

Oliynyk O, Barg W, Slifirczyk A, Oliynyk Y, Gurianov V, Rorat M. Efficacy of Tocilizumab Therapy in Different Subtypes of COVID-19 Cytokine Storm Syndrome. Viruses. 2021; 13(6):1067. https://doi.org/10.3390/v13061067

Chicago/Turabian Style

Oliynyk, Oleksandr, Wojciech Barg, Anna Slifirczyk, Yanina Oliynyk, Vitaliy Gurianov, and Marta Rorat. 2021. "Efficacy of Tocilizumab Therapy in Different Subtypes of COVID-19 Cytokine Storm Syndrome" Viruses 13, no. 6: 1067. https://doi.org/10.3390/v13061067

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