Copyright
©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Retrospective analysis of anti-inflammatory therapies during the first wave of COVID-19 at a community hospital
Jose I Iglesias, Andrew V Vassallo, Jesse B Sullivan, Yasmine Elbaga, Vishal V Patel, Nikunjkumar Patel, Lydia Ayad, Payam Benson, Marina Pittiglio, Emad Gobran, Alexander Clark, Wajahat Khan, Kaliope Damalas, Rajesh Mohan, Satyendra P Singh
Jose I Iglesias, Wajahat Khan, Department of Critical Care, Community Medical Center, Toms River, NJ 08757, United States
Jose I Iglesias, Department of Nephrology, Community Medical Center, Toms River, NJ 08757, United States
Jose I Iglesias, Department of Nephrology, Jersey Shore University Medical Center, Hackensack Meridian School of Medicine at Seton Hall, Neptune, NJ 07753, United States
Andrew V Vassallo, Vishal V Patel, Marina Pittiglio, Kaliope Damalas, Department of Pharmacy, Community Medical Center, Toms River, NJ 08757, United States
Jesse B Sullivan, Fairleigh Dickinson University School of Pharmacy & Health Sciences, Fairleigh Dickinson University, Florham Park, NJ 07932, United States
Yasmine Elbaga, Alexander Clark, Department of Pharmancy, Monmouth Medical Center Southern Campus, Lakewood, NJ 08701, United States
Nikunjkumar Patel, Lydia Ayad, Payam Benson, Emad Gobran, Department of Medicine, Community Medical Center, Toms River, NJ 08757, United States
Rajesh Mohan, Department of Cardiology, Monmouth Medical Center Southern Campus, Lakewood, NJ 08701, United States
Satyendra P Singh, Department of Medicine, Monmouth Medical Center Southern Campus, Lakewood, NJ 08701, United States
Author contributions: Iglesias JI and Vassallo AV contributed to conceptualization, methodology, and formal analysis; Iglesias JI, Vassallo AV, Sullivan JB, Elbaga Y and Patel VV wrote the original draft; Data collection along with manuscript review and editing was performed by Iglesias JI, Vassallo AV, Elbaga Y, Patel N, Gobran E, Ayad L, Pittiglio M, Khan W, Benson P, Damalas K, Clark A, Singh SP, and Mohan R.
Institutional review board statement: The study was approved by the Community Medical Center Institutional Review Board (IRB # 20-005).
Informed consent statement: Informed consent was waived by the Community Medical Center Institutional Review Board as the study was deemed minimal risk to participants due to its retrospective nature and de-identified results.
Conflict-of-interest statement: None of the listed authors have any conflicts of interest to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Jose I Iglesias, DO, Associate Professor, Department of Critical Care, Community Medical Center, 99 W Rt 37, Toms River, NJ 08757, United States. jiglesias23@gmail.com
Received: April 21, 2021
Peer-review started: April 21, 2021
First decision: June 17, 2021
Revised: June 23, 2021
Accepted: August 4, 2021
Article in press: August 4, 2021
Published online: September 9, 2021
Processing time: 140 Days and 17.9 Hours
BACKGROUND
Our understanding of the severe acute respiratory syndrome coronavirus 2 has evolved since the first reported cases in December 2019, and a greater emphasis has been placed on the hyper-inflammatory response in severely ill patients. The purpose of this study was to determine risk factors for mortality and the impact of anti-inflammatory therapies on survival.
AIM
To determine the impact of various therapies on outcomes in severe coronavirus disease 2019 patients with a focus on anti-inflammatory and immune-modulating agents.
METHODS
A retrospective analysis was conducted on 261 patients admitted or transferred to the intensive care unit in two community hospitals between March 12, 2020 and June 17, 2020. Totally 167 patients received glucocorticoid (GC) therapy. Seventy-three patients received GC alone, 94 received GC and tocilizumab, 28 received tocilizumab monotherapy, and 66 received no anti-inflammatory therapy.
RESULTS
Patient survival was associated with GC use, either alone or with tocilizumab, and decreased vasopressor requirements. Delayed administration of GC was found to decrease the survival benefit of GC therapy. No difference in survival was found with varying anticoagulant doses, convalescent plasma, tocilizumab monotherapy; prone ventilation, hydroxychloroquine, azithromycin, or intravenous ascorbic acid use.
CONCLUSION
This analysis demonstrated the survival benefit associated with anti-inflammatory therapy of GC, with or without tocilizumab, with the combination providing the most benefit. More studies are needed to assess the optimal timing of anti-inflammatory therapy initiation.
Core Tip: Anti-inflammatory therapy with glucocorticoids (including methylpredsnisolone) and combination treatment with tocilizumab and glucocorticoids improve survival in critically ill patients with coronavirus disease 2019. Dual inhibition of the NFK-β therapy with glucocorticoid and inhibition of the interleukin-6 pathway with tocilizumab may offer greater survival benefits.
