251. Association Between Early Treatment With Tocilizumab and Mortality Among Critically Ill Patients With COVID-19
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Gupta, Shruti, Wang, Wei, Hayek, Salim S., Chan, Lili, Mathews, Kusum S., Melamed, Michal L., Brenner, Samantha K., Leonberg-Yoo, Amanda, Schenck, Edward J., Radbel, Jared, Reiser, Jochen, Bansal, Anip, Srivastava, Anand, Zhou, Yan, Finkel, Diana, Green, Adam, Mallappallil, Mary, Faugno, Anthony J., Zhang, Jingjing, Velez, Juan Carlos Q., Shaefi, Shahzad, Parikh, Chirag R., Charytan, David M., Athavale, Ambarish M., Friedman, Allon N., Redfern, Roberta E., Short, Samuel A. P., Correa, Simon, Pokharel, Kapil K., Admon, Andrew J., Donnelly, John P., Gershengorn, Hayley B., Douin, David J., Semler, Matthew W., Hernán, Miguel A., Leaf, David E., Walther, Carl P., Anumudu, Samaya J., Arunthamakun, Justin, Kopecky, Kathleen F., Milligan, Gregory P., McCullough, Peter A., Nguyen, Thuy-Duyen, Krajewski, Megan L., Shankar, Sidharth, Pannu, Ameeka, Valencia, Juan D., Waikar, Sushrut S., Kibbelaar, Zoe A., Hart, Peter, Upadhyay, Shristi, Vohra, Ishaan, Oyintayo, Ajiboye, Rachoin, Jean-Sebastien, Schorr, Christa A., Shea, Lisa, Edmonston, Daniel L., Mosher, Christopher L., Shehata, Alexandre M., Cohen, Zaza, Allusson, Valerie, Bambrick-Santoyo, Gabriela, Bhatti, Noor ul aain, Mehta, Bijal, Williams, Aquino, Walters, Patricia, Go, Ronaldo C., Rose, Keith M., Lisk, Rebecca, Zhou, Amy M., Kim, Ethan C., Coca, Steven G., Altman, Deena R., Saha, Aparna, Soh, Howard, Wen, Huei Hsun, Bose, Sonali, Leven, Emily A., Wang, Jing G., Mosoyan, Gohar, Nadkarni, Girish N., Pattharanitima, Pattharawin, Gallagher, Emily J., Guirguis, John, Kapoor, Rajat, Meshberger, Christopher, Kelly, Katherine J., Garibaldi, Brian T., Corona-Villalobos, Celia P., Wen, Yumeng, Menez, Steven, Malik, Rubab F., Cervantes, Carmen Elena, Gautam, Samir C., Mallappallil, Mary C., Ouyang, Jie, John, Sabu, Yap, Ernie, Melaku, Yohannes, Mohamed, Ibrahim, Bajracharya, Siddhartha, Puri, Isha, Thaxton, Mariah, Bhattacharya, Jyotsna, Wagner, John, Boudourakis, Leon, Nguyen, H. Bryant, Ahoubim, Afshin, Kashani, Kianoush, Tehranian, Shahrzad, Thomas, Leslie F., Sirganagari, Dheeraj Reddy, Guru, Pramod K., Bergl, Paul A., Rodriguez, Jesus, Shah, Jatan A., Gupta, Mrigank S., Kumar, Princy N., Lazarous, Deepa G., Kassaye, Seble G., Johns, Tanya S., Mocerino, Ryan, Prudhvi, Kalyan, Zhu, Denzel, Levy, Rebecca V., Azzi, Yorg, Fisher, Molly, Yunes, Milagros, Sedaliu, Kaltrina, Golestaneh, Ladan, Brogan, Maureen, Kumar, Neelja, Chang, Michael, Thakkar, Jyotsana, Raichoudhury, Ritesh, Athreya, Akshay, Farag, Mohamed, Cho, Soo Jung, Plataki, Maria, Alvarez-Mulett, Sergio L., Gomez-Escobar, Luis G., Pan, Di, Lee, Stefi, Krishnan, Jamuna, Whalen, William, Charytan, David, Macina, Ashley, Chaudhry, Sobaata, Wu, Benjamin, Modersitzki, Frank, Leidner, Alexander S., Martinez, Carlos, Kruser, Jacqueline M., Wunderink, Richard G., Hodakowski, Alexander J., Price-Haywood, Eboni G., Matute-Trochez, Luis A., Hasty, Anna E., Mohamed, Muner MB., Avasare, Rupali S., Zonies, David, Sise, Meghan E., Newman, Erik T., Omar, Samah Abu, Sharma, Shreyak, Singh, Harkarandeep, Shaukat, Tanveer, Kamal, Omer, Yang, Heather, Boateng, Jeffery O., Lee, Meghan, Strohbehn, Ian A., Li, Jiahua, Mueller, Ariel L., Cairl, Nicholas S., Naimy, Gabriel, Abu-Saif, Abeer, Hall, Danyell, Bickley, Laura, Rowan, Chris, Madhani-Lovely, Farah, Peev, Vasil, Byun, John J., Vissing, Andrew, Kapania, Esha M., Post, Zoe, Patel, Nilam P., Hermes, Joy-Marie, Sutherland, Anne K., Patrawalla, Amee, Finkel, Diana G., Danek, Barbara A., Arikapudi, Sowminya, Paer, Jeffrey M., Cangialosi, Peter, Liotta, Mark, Puri, Sonika, Sunderram, Jag, Scharf, Matthew T., Ahmed, Ayesha, Berim, Ilya, Vatson, Jayanth S., Anand, Shuchi, Levitt, Joseph E., Garcia, Pablo, Boyle, Suzanne M., Song, Rui, Arif, Ali, Woo, Sang Hoon, Deng, Xiaoying, Katz-Greenberg, Goni, Senter, Katharine, Sharshir, Moh’d A., Rusnak, Vadym V., Ali, Muhammad Imran, Peters, Terri, Hughes, Kathy, Podoll, Amber S., Chonchol, Michel, Sharma, Sunita, Burnham, Ellen L., Rashidi, Arash, Hejal, Rana, Judd, Eric, Latta, Laura, Tolwani, Ashita, Albertson, Timothy E., Adams, Jason Y., Chang, Steven Y., Beutler, Rebecca M., Schulze, Carl E., Macedo, Etienne, Rhee, Harin, Liu, Kathleen D., Jotwani, Vasantha K., Koyner, Jay L., Shah, Chintan V., Jaikaransingh, Vishal, Toth-Manikowski, Stephanie M., Joo, Min J., Lash, James P., Neyra, Javier A., Chaaban, Nourhan, Elias, Madona, Ahmad, Yahya, Iardino, Alfredo, Au, Elizabeth H., Sharma, Jill H., Sosa, Marie Anne, Taldone, Sabrina, Contreras, Gabriel, Zerda, David De La, Fornoni, Alessia, Blakely, Pennelope, Berlin, Hanna, Azam, Tariq U., Shadid, Husam, Pan, Michael, O’ Hayer, Patrick, Meloche, Chelsea, Feroze, Rafey, Padalia, Kishan J., Bitar, Abbas, Leya, Jeff, Flythe, Jennifer E., Tugman, Matthew J., Chang, Emily H., Brown, Brent R., Leonberg-Yoo, Amanda K., Spiardi, Ryan C., Miano, Todd A., Roche, Meaghan S., Vasquez, Charles R., Bansal, Amar D., Ernecoff, Natalie C., Kapoor, Sanjana, Verma, Siddharth, Chen, Huiwen, Kovesdy, Csaba P., Molnar, Miklos Z., Azhar, Ambreen, Hedayati, S. Susan, Nadamuni, Mridula V., Shastri, Shani, Willett, Duwayne L., Short, Samuel A.P., Renaghan, Amanda D., Enfield, Kyle B., Bhatraju, Pavan K., Malik, A. Bilal, Vijayan, Anitha, Joy, Christina Mariyam, Li, Tingting, Goldberg, Seth, Kao, Patricia F., Schumaker, Greg L., Goyal, Nitender, Hsu, Caroline M., Tariq, Asma, Meyer, Leah, Kshirsagar, Ravi K., Jose, Aju, Weiner, Daniel E., Christov, Marta, Griffiths, Jennifer, Gupta, Sanjeev, Kapoor, Aromma, Wilson, Perry, Arora, Tanima, and Ugwuowo, Ugochukwu
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musculoskeletal diseases ,medicine.medical_specialty ,Population ,01 natural sciences ,law.invention ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Tocilizumab ,Interquartile range ,law ,Intensive care ,Internal medicine ,Fraction of inspired oxygen ,medicine ,Internal Medicine ,030212 general & internal medicine ,0101 mathematics ,education ,Original Investigation ,education.field_of_study ,business.industry ,010102 general mathematics ,Hazard ratio ,Intensive care unit ,chemistry ,business ,Cohort study - Abstract
IMPORTANCE: Therapies that improve survival in critically ill patients with coronavirus disease 2019 (COVID-19) are needed. Tocilizumab, a monoclonal antibody against the interleukin 6 receptor, may counteract the inflammatory cytokine release syndrome in patients with severe COVID-19 illness. OBJECTIVE: To test whether tocilizumab decreases mortality in this population. DESIGN, SETTING, AND PARTICIPANTS: The data for this study were derived from a multicenter cohort study of 4485 adults with COVID-19 admitted to participating intensive care units (ICUs) at 68 hospitals across the US from March 4 to May 10, 2020. Critically ill adults with COVID-19 were categorized according to whether they received or did not receive tocilizumab in the first 2 days of admission to the ICU. Data were collected retrospectively until June 12, 2020. A Cox regression model with inverse probability weighting was used to adjust for confounding. EXPOSURES: Treatment with tocilizumab in the first 2 days of ICU admission. MAIN OUTCOMES AND MEASURES: Time to death, compared via hazard ratios (HRs), and 30-day mortality, compared via risk differences. RESULTS: Among the 3924 patients included in the analysis (2464 male [62.8%]; median age, 62 [interquartile range {IQR}, 52-71] years), 433 (11.0%) received tocilizumab in the first 2 days of ICU admission. Patients treated with tocilizumab were younger (median age, 58 [IQR, 48-65] vs 63 [IQR, 52-72] years) and had a higher prevalence of hypoxemia on ICU admission (205 of 433 [47.3%] vs 1322 of 3491 [37.9%] with mechanical ventilation and a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen of
- Published
- 2021
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