Int J Biol Sci 2021; 17(8):2124-2134. doi:10.7150/ijbs.56952

Research Paper

Inflammation characteristics and anti-inflammation treatment with tocilizumab of severe/critical COVID-19 patients: A retrospective cohort study

Qin Hu1#, Yu Xu2#, Ying Xiang1#, Bin Wang2, Zhiquan Yuan1, Yifan Shan1, Wenjing Zhang2, Na Wu1, Tingting Xia1, Chengying Li1, Weijia Xie1, Xiaoyue Jia1, Zubin Yu3*, Li Bai2*, Yafei Li1✉*

1. Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, People's Republic of China.
2. Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Army Medical University, Chongqing 400037, People's Republic of China.
3. Department of Thoracic Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing 400037, People's Republic of China.
# These authors contributed equally to this work.
* These authors jointly directed the project and share the corresponding authorship.

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Citation:
Hu Q, Xu Y, Xiang Y, Wang B, Yuan Z, Shan Y, Zhang W, Wu N, Xia T, Li C, Xie W, Jia X, Yu Z, Bai L, Li Y. Inflammation characteristics and anti-inflammation treatment with tocilizumab of severe/critical COVID-19 patients: A retrospective cohort study. Int J Biol Sci 2021; 17(8):2124-2134. doi:10.7150/ijbs.56952. Available from https://www.ijbs.com/v17p2124.htm

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Abstract

The efficacy of tocilizumab on the prognosis of severe/critical COVID-19 patients is still controversial so far. We aimed to delineate the inflammation characteristics of severe/critical COVID-19 patients and determine the impact of tocilizumab on hospital mortality. Here, we performed a retrospective cohort study which enrolled 727 severe or critical inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Huoshenshan Hospital (Wuhan, China), among which 50 patients received tocilizumab. This study confirmed that most recovered patients manifested relatively normal inflammation levels at admission, whereas most of the deceased cases presented visibly severe inflammation at admission and even progressed into extremely aggravated inflammation before their deaths, proved by some extremely high concentrations of interleukin-6, procalcitonin, C-reactive protein and neutrophil count. Moreover, based on the Cox proportional-hazards models before or after propensity score matching, we demonstrated that tocilizumab treatment could lessen mortality by gradually alleviating excessive inflammation and meanwhile continuously enhancing the levels of lymphocytes within 14 days for severe/critical COVID-19 patients, indicating potential effectiveness for treating COVID-19.

Keywords: COVID-19, Severe and critical patients, Inflammatory factors, Anti-inflammation treatment, Tocilizumab