对于需要有创通气的ARDS COVID-19患者的免疫抑制策略
对于需要有创通气的ARDS COVID-19患者的免疫抑制策略
贵州医科大学 麻醉与心脏电生理课题组
翻译：陈锐 编辑：陈锐 审校：曹莹
新冠肺炎与炎性细胞因子水平升高有关。我们研究了在重症监护病房(ICU)接受免疫抑制药物托西珠单抗(Tocilizumab)或阿纳金纳(Anakinra)治疗的患者与对照组相比的特点和结果。
一项针对在重症监护病房进行有创通气新冠肺炎患者的单中心前瞻性观察研究。主要结果是第28天的临床改善。使用了贝叶斯框架，所有的分析都针对混杂因素进行了调整。
研究总体包括61名连续有创通气患者，其中9名患者 (14.7%) 接受托珠单抗，15名 (24.6%) 接受阿那白滞素。在前7天，使用托珠单抗患者的C反应蛋白大幅度下降（P<0.001）。调整混杂因素后，与对照组相比，托珠单抗在第 28 天临床改善的概率为 7.6% (OR=0.36 [95% CrI: 0.09–1.46])使用用白介素受体阻断剂的患者为 40.9% (OR=0.89 [95% CrI: 0.32]) –2.43])。在第28天，使用托珠单抗的患者获得更好临床改善的概率为 2.5%（OR=2.98 [95% CrI：1.00-8.88]），而使用白介素受体阻断剂的患者为49.5%（OR=1.00 [95% CrI：0.42-2.42]）。
在使用有创通气的COVID-19患者中，与托珠单抗相比，白介素受体阻断剂治疗与更高的临床改善概率相关；然而，与对照组相比，这两种药物的治疗都没有产生具有临床意义的改善。
Monti G, Campochiaro C, Zangrillo A, et al.; the COVID-BioB Study Group. Immunosuppressive strategies in invasively ventilated ARDS COVID-19 patients. Minerva Anestesiol 2021;87:891-902. DOI: 10.23736/S0375-9393.21.15339-8)
Immunosuppressive strategies in invasively ventilated ARDS COVID-19 patients
ABSTRACT
BACKGROUND: COVID-19 is associated with elevated levels of inflammatory cytokines. We present the characteristics and outcomes of patients treated in the Intensive Care Unit (ICU) with immunosuppressive drugs, either tocilizumab or anakinra compared with controls.
METHODS: A single-center observational prospective study on ICU invasively ventilated COVID-19 patients. The primary outcome was the clinical improvement at day 28. A Bayesian framework was employed, and all analyses were adjusted for confounders.
RESULTS: Sixty-one consecutive invasively ventilated patients were included, nine (14.7%) received tocilizumab and 15 (24.6%) received anakinra. Over the first seven days, tocilizumab was associated with a greater decrease in C-reactive protein (P<0.001). After adjusting for confounders, the probability of clinical improvement at day 28 compared to control was 7∙6% (OR=0.36 [95% CrI: 0.09–1.46]) for tocilizumab and 40.9% (OR=0.89 [95% CrI: 0.32–2.43]) for anakinra. At day 28, the probability of being in a better clinical category was 2.5% (OR=2.98 [95% CrI: 1.00–8.88]) for tocilizumab, and 49.5% (OR=1.00 [95% CrI: 0.42–2.42]) for anakinra.
CONCLUSIONS: In invasively ventilated COVID-19 patients, treatment with anakinra was associated with a higher probability of clinical improvement compared to tocilizumab; however, treatment with either drug did not result in clinically meaningful improvements compared with controls.
(Cite this article as: Monti G, Campochiaro C, Zangrillo A, Scandroglio AM, Fominskiy E, Cavalli G, et al.; the COVID-BioB Study Group. Immunosuppressive strategies in invasively ventilated ARDS COVID-19 patients. Minerva Anestesiol 2021;87:891-902. DOI: 10.23736/S0375-9393.21.15339-8)
KEY WORDS: COVID-19; Tocilizumab; Respiration, artificial; Intensive Care Units; Critical care.