Clinical efficacy of tocilizumab treatment in severe and critical COVID-19 patients

doi:10.12998/wjcc.v8.i17.3763

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World Journal of Clinical Cases

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World J Clin Cases. Sep 6, 2020; 8(17): 3763-3773
Published online Sep 6, 2020. doi: 10.12998/wjcc.v8.i17.3763

Table 1 General information on patients and laboratory test results before and after treatment with tocilizumab

Group	Age (yr)	M:F	Critical: severe	Laboratory test items	Before treatment	1^st day after treatment	3^rd day after treatment	5^th day after treatment	10^th day after treatment	Statistical value	P value
Effective	55-94 (74 ± 10.66)	9:4	3:10	SaO₂ (%)	80-93 (86.38 ± 5.21)
				Lymphocyte (× 10⁹/L)	0.30-1.56 (0.67 ± 0.33)	0.51-2.07 (0.92 ± 0.49)	0.29-1.75 (0.90 ± 0.52)	0.59-1.91 (1.20 ± 0.46)	0.58-2.38 (1.32 ± 0.57)	3.76	0.0085
				WBC (× 10⁹/L)	3.5-15.1 (9.47 ± 4.11)	5.1-13.7 (8.8 ± 3.25)	3.4-19.7 (9.08 ± 4.72)	3.3-21.6 (9.13 ± 5.40)	3.7-17.7 (9.6 ± 5.35)	0.06	0.9927
				PLT (× 10⁹/L)	80-456 (220.92 ± 110.19)	70-396 (226.55 ± 115.44)	54-370 (192.4 ± 96.51)	53-384 (226.25 ± 112.38)	46-324 (208.1 ± 77.42)	0.26	0.9026
				CRP (mg/L)	10.85-235.29 (63.76 ± 67.83)	4.43-231.35 (63.31 ± 64.77)	3.83-99.75 (23.36 ± 30.93)	1.03-15.33 (6.11 ± 4.44)	0.14-14.61 (2.42 ± 4.33)	5.91	0.0004
				Lactic acid (mmol/L)	1.10-6.20 (2.65 ± 1.38)	1.10-2.10 (1.72 ± 0.41)	1.40-3.20 (2.28 ± 0.82)	1.40-5.80 (3.12 ± 1.81)	0.40-2.50 (1.45 ± 1.48)	3.64	0.0102
				LDH (U/L)	187-633 (356 ± 198.2)	206-609 (333.8 ± 166.38)	207-949 (421.5 ± 353.52)	185-1085 (391.8 ± 388.05)	192-520 (269.75 ± 168.68)	0.59	0.6704
				Oxygenation index (mmHg)	67-300 (166 ± 67.13)	98-385 (204.08 ± 94.22)	98-395 (231.17 ± 93.95)	122-380 (254.25 ± 79.4)	216-397 (327.42 ± 62.02)	7.35	0.0001
				FIB (g/L)	2.05-9.46 (4.84 ± 2.09)	3.55-4.57 (3.9 ± 0.39)	1.16-4.66 (3.1 ± 1.29)	1.41-5.64 (2.88 ± 1.29)	0.97-2.13 (1.5 ± 0.37)	12.56	0.0000
				IL-6 (pg/mL)	30.37-609.36 (107.17 ± 154.91)	36.59-12600.94 (1793.42 ± 3675.7)	73.80-7295.1 (1286.84 ± 2291.07)	24.05-2502.67 (541.42 ± 687.93)	14-1109.47 (286.33 ± 342.37)	11.71	0.0016
				D-dimer (mg/L)	0.98-12.21 (3.5 ± 3.71)	0.66-26.11 (5.62 ± 10.09)	0.78-20.26 (5.75 ± 6.73)	0.73-29.48 (6.4 ± 9.53)	1.28-4.2 (2.2 ± 0.89)	0.81	0.5260
Ineffective	57-88 (83 ± 11.93)¹	4:2	5:1¹	SaO₂ (%)	70-88 (77.67 ± 8.89)¹
				Lymphocyte (× 10⁹/L)	0.15-1.74 (0.69 ± 0.56)	0.08-1.59 (0.68 ± 0.59)	0.36-0.17 (0.41 ± 0.27)¹	0.18-0.98 (0.62 ± 0.4)¹	0.29-0.66 (0.5 ± 0.15)¹	0.29	0.8816
				WBC (× 10⁹/L)	3.7-26.0 (10.68 ± 8.02)	2.9-22.1 (9.92 ± 8.72)	4-11.8 (8.33 ± 3.71)	7.5-10.3 (9.03 ± 1.49)	4.7-14.1 (8 ± 4.22)	0.21	0.9290
				PLT (× 10⁹/L)	41-338 (160.67 ± 102.66)	11-313 (153.8 ± 110.39)	113-301 (171.5 ± 84.47)	76-287 (137.65 ± 100.42)	40-276 (147.75 ± 98.65)	0.10	0.9817
				CRP (mg/L)	39.78-241.53 (122.8 ± 83.7)	34.65-254.52 (98.38 ± 90.03)	9.51-20.89 (15.44 ± 5.26)	7.45-11.86 (9.08 ± 1.52)	3.2-53.33 (17.05 ± 24.22)¹	5.51	0.0025
				Lactic acid (mmol/L)	1.1-3.4 (2.38 ± 0.96)	1.7-2.36 (2.09 ± 0.34)	Untested	Untested	12.58 (12.58)¹	194.84	0.0000
				LDH (U/L)	203-345 (274 ± 100.41)	275-338 (306.5 ± 44.55)	320-542 (427.33 ± 111.18)	308-687 (497.5 ± 267.99)	488-673 (580.5 ± 130.82)¹	4.37	0.0082
				Oxygenation index (mmHg)	51-180 (106.34 ± 52.53)	59.1-266 (137.02 ± 83.46)	82-283 (185 ± 82.13)	94-200 (141.75 ± 45.49)¹	84-200 (124.5 ± 53.12)¹	1.20	0.3374
				FIB (g/L)	1.59-4.87 (3.77 ± 1.26)	1.34-3.21 (2.48 ± 1)	0.85-5.29 (2.68 ± 2.32)	1.09-3.1 (1.82 ± 0.93)	0.88-2.4 (1.42 ± 0.85)	1.77	0.1817
				IL-6 (pg/mL)	30.63-157.08 (78.27 ± 43.81)	167.08-2124.42 (878.54 ± 911.52)¹	559.96-23138.48 (6644.37 ± 11006.23)¹	990.81-2725.70 (1703.35 ± 907.99)¹	44.95-50000 (20562.42 ± 26144.85)¹	3.01	0.0478
				D-Dimer (mg/L)	0.40-53.81 (11.63 ± 20.8)¹	1.29-69.56 (29.7 ± 35.55)¹	3.16-24.6 (10.91 ± 11.89)	5.44-15.63 (9.81 ± 6.74)	1.75-6.88 (4.06 ± 2.6)	0.83	0.5223

¹Comparison between the two groups of the same item (P < 0.05). WBC: White blood cell; PLT: Platelet; CRP: C-reactive protein; IL-6: Interleukin-6.

Table 2 Improvement of oxygen therapy in patients before and after tocilizumab treatment

		The number of patients before treatment with tocilizumab
		ECMO (n = 1)	Invasive ventilator (n = 3)	High flow oxygen (n = 14)	Nasal catheter oxygen (n = 1)
Number of patients after treatment with tocilizumab	Death	0	1	3	0
	ECMO	0	0	0	0
	Invasive ventilator	1	1	0	0
	Noninvasive ventilator	0	1	0	0
	High flow oxygen	0	0	1	0
	Nasal catheter oxygen	0	0	6	0
	Non oxygen inhalation	0	0	4	1
	Improved	1 (100%)	1 (33.3%)	10 (71.4%)	1 (100%)

ECMO: Extracorporeal membrane oxygenation.

Citation: Zeng J, Xie MH, Yang J, Chao SW, Xu EL. Clinical efficacy of tocilizumab treatment in severe and critical COVID-19 patients. World J Clin Cases 2020; 8(17): 3763-3773
URL: https://www.wjgnet.com/2307-8960/full/v8/i17/3763.htm
DOI: https://dx.doi.org/10.12998/wjcc.v8.i17.3763