| الملخص: | Objective: The global severe acute respiratory syndrome-coronavirus-2 pandemic, which emerged in 2019, has resulted in severe complications in approximately 5% of infected individuals, leading to mortality due to respiratory failure, shock, or multiple organ dysfunction. Mortality is primarily attributed to excessive hyperinflammatory response-induced alveolar damage, which subsequently progresses to severe acute respiratory distress syndrome. Tocilizumab, a monoclonal antibody targeting the interleukin-6 receptor, has been utilized in the management of cytokine release syndrome (CRS) and is hypothesized to mitigate alveolar hyperinflammation, thereby reducing disease severity.
Method: This retrospective study analyzed 76 patients diagnosed with coronavirus disease-2019 (COVID-19) pneumonia and developing CRS in the intensive care unit. The patients were divided into two groups: 39 patients who received tocilizumab (Group T) and 37 patients who did not receive tocilizumab (Group C). The primary objective of the study was to assess the effect of tocilizumab on the PaO2/FiO2 ratio in critically ill COVID-19 pneumonia patients requiring mechanical ventilatory support. The secondary objective was to evaluate changes in inflammatory and coagulation biomarkers between the groups at different time points during intensive care follow-up.
Results: Patients who received tocilizumab demonstrated a significant improvement in the PaO2/FiO2 ratio on the seventh day of follow-up. In addition, C-reactive protein (CRP) levels showed a statistically significant reduction on the third and seventh days, while fibrinogen levels significantly decreased on the seventh day. A notable increase in lymphocyte count was also observed on the seventh day.
Conclusion: In critically ill COVID-19 pneumonia patients requiring mechanical ventilatory support, tocilizumab administration was found to be beneficial in attenuating alveolar damage and oxygenation impairment associated with CRS. The significant improvement in the PaO2/FiO2 ratio, along with favorable changes in inflammatory and coagulation biomarkers such as CRP, fibrinogen, and lymphocyte count, suggests that tocilizumab may play a therapeutic role in the management of severe COVID-19 cases.
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