Development and validation of a prediction model for tocilizumab failure in hospitalized patients with SARS-CoV-2 infection

Cristina Mussini, Alessandro Cozzi-Lepri, Marianna Menozzi, Marianna Meschiari, Erica Franceschini, Jovana Milic, Lucio Brugioni, Antonello Pietrangelo, Massimo Girardis, Andrea Cossarizza, Roberto Tonelli, Enrico Clini, Marco Massari, Michele Bartoletti, Anna Ferrari, Anna Maria Cattelan, Paola Zuccalà, Miriam Lichtner, Roberto Rossotti, Enrico GirardiEmanuele Nicastri, Massimo Puoti, Andrea Antinori, Pierluigi Viale, Giovanni Guaraldi

Результат исследований: Материалы для журналаСтатьярецензирование


Background The aim of this secondary analysis of the TESEO cohort is to identify, early in the course of treatment with tocilizumab, factors associated with the risk of progressing to mechanical ventilation and death and develop a risk score to estimate the risk of this outcome according to patients' profile. Methods Patients with COVID-19 severe pneumonia receiving standard of care + tocilizumab who were alive and free from mechanical ventilation at day 6 after treatment initiation were included in this retrospective, multicenter cohort study. Multivariable logistic regression models were built to identify predictors of mechanical ventilation or death by day-28 from treatment initiation and β-coefficients were used to develop a risk score. Secondary outcome was mortality. Patients with the same inclusion criteria as the derivation cohort from 3 independent hospitals were used as validation cohort. Results 266 patients treated with tocilizumab were included. By day 28 of hospital follow-up post treatment initiation, 40 (15%) underwent mechanical ventilation or died [26 (10%)]. At multivariable analysis, sex, day-4 PaO2/FiO2 ratio, platelets and CRP were independently associated with the risk of developing the study outcomes and were used to generate the proposed risk score. The accuracy of the score in AUC was 0.80 and 0.70 in internal validation and test for the composite endpoint and 0.92 and 0.69 for death, respectively. Conclusions Our score could assist clinicians in identifying, early after tocilizumab administration, patients who are likely to progress to mechanical ventilation or death, so that they could be selected for eventual rescue therapies.
Язык оригиналаАнглийский
ЖурналPLoS ONE
Номер выпуска2 February
СостояниеОпубликовано - 1 фев 2021


Подробные сведения о темах исследования «Development and validation of a prediction model for tocilizumab failure in hospitalized patients with SARS-CoV-2 infection». Вместе они формируют уникальный семантический отпечаток (fingerprint).