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Rubio-Rivas M, Ronda M, Padulles A, Mitjavila F, Riera-Mestre A, García-Forero C, Iriarte A, Mora JM, Padulles N, Gonzalez M, Solanich X, Gasa M, Suarez G, Sabater J, Perez-Fernandez XL, Santacana E, Leiva E, Ariza-Sole A, Dallaglio PD, Quero M, Soriano A, Pasqualetto A, Koo M, Esteve V, Antoli A, Moreno R, Yun S, Cerda P, Llaberia M, Formiga F, Fanlo M, Montero A, Chivite D, Capdevila O, Bolao F, Pinto X, Llop J, Sabate A, Guardiola J, Cruzado JM, Comin-Colet J, Santos S, Jodar R, Corbella X. Beneficial Effect of Corticosteroids in Preventing Mortality in Patients Receiving Tocilizumab to Treat Severe COVID-19 Illness. Int J Infect Dis. 2020 Oct 6:S1201-9712(20)32202-5. doi: 10.1016/j.ijid.2020.09.1486. Epub ahead of print. PMID: 33035673; PMCID: PMC7537652.

Objectives: To assess the characteristics and risk factors for mortality in patients with severe COVID-19 treated with tocilizumab (TCZ), alone or in combination with corticosteroids (CS).

Methods: From March 17 to April 7, 2020, a real-world observational retrospective analysis of consecutive hospitalized adult patients receiving TCZ to treat severe COVID-19 was conducted at our 750-bed university hospital. The main outcome was all-cause in-hospital mortality.

Results: A total of 1,092 COVID-19 patients were admitted during the study period. Of them, 186 (17%) were treated with TCZ, of which 129 (87.8%) in combination with CS. Of the total 186, 155 (83.3 %) patients were receiving non-invasive ventilation when TCZ was initiated. Mean time from symptoms onset and hospital admission to TCZ use was 12 (± 4.3) and 4.3 days (± 3.4), respectively. Overall, 147 (79%) survived and 39 (21%) died. By multivariate analysis, mortality was associated with older age (HR = 1.09, p < 0.001), chronic heart failure (HR = 4.4, p = 0.003), and chronic liver disease (HR = 4.69, p = 0.004). The use of CS, in combination with TCZ, was identified as protective factor against mortality (HR = 0.26, p < 0.001) in such severe COVID-19 patients receiving TCZ. No serious superinfections were observed after a 30-day follow-up.

Conclusions: In severe COVID-19 patients receiving TCZ due to systemic host-immune inflammatory response syndrome, the use of CS in addition to TCZ therapy, showed beneficial effect in preventing in-hospital mortality.

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