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. 2020 May 15;104444.
doi: 10.1016/j.jcv.2020.104444. Online ahead of print.

Profiling COVID-19 Pneumonia Progressing Into the Cytokine Storm Syndrome: Results From a Single Italian Centre Study on Tocilizumab Versus Standard of Care

Free PMC article

Profiling COVID-19 Pneumonia Progressing Into the Cytokine Storm Syndrome: Results From a Single Italian Centre Study on Tocilizumab Versus Standard of Care

Luca Quartuccio et al. J Clin Virol. .
Free PMC article


Objective: Approximately 5% of patients with coronavirus disease 2019 (COVID-19) develop a life-threatening pneumonia that often occurs in the setting of increased inflammation or "cytokine storm". Anti-cytokine treatments are being evaluated but optimal patient selection remains unclear, and the aim of our study is to address this point.

Methods: Between February 29 to April 6, 2020, 111 consecutive hospitalized patients with COVID-19 pneumonia were evaluated in a single centre retrospective study. Patients were divided in two groups: 42 severe cases (TOCI) with adverse prognostic features including raised CRP and IL-6 levels, who underwent anti-cytokine treatments, mostly tocilizumab, and 69 standard of care patients (SOC).

Results: In the TOCI group, all received anti-viral therapy and 40% also received glucocorticoids. In TOCI, 62% of cases were ventilated and there were 3 deaths (17.8 ± 10.6 days, mean follow up) with 7/26 cases remaining on ventilators, without improvement, and 17/26 developed bacterial superinfection. One fatality occurred in the 15 TOCI cases treated on noninvasive ventilation and 1 serious bacterial superinfection. Of the 69 cases in SOC, there was no fatalities and no bacterial complications. The TOCI group had higher baseline CRP and IL-6 elevations (p < 0.0001 for both) and higher neutrophils and lower lymphocyte levels (p = 0.04 and p = 0.001, respectively) with the TOCI ventilated patients having higher markers than non-ventilated TOCI patients.

Conclusion: Higher inflammatory markers, more infections and worse outcomes characterized ventilated TOCI cases compared to ward based TOCI. Despite the confounding factors, this suggests that therapy time in anti-cytokine randomized trials will be key.

Keywords: COVID-19; coronavirus; cytokine; intensive care; tocilizumab.


Fig. 1
Fig. 1
The chart illustrates the outcomes of the two treatment groups. Legend: TOCI, anti-cytokine group; SOF, standard of care group; MOF, multi-organ failure; ICU, intensive care unit; NIV, noninvasive ventilation; PE, pulmonary embolism.

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