Tocilizumab Initiation based on Indicator in Patients Infected by Coronavirus-19 to Prevent Intubation

Septian Adi  Permana; Adhrie  Sugiarto; Sidharta Kusuma  Manggala; Muhammad Husni  Thamrin; Purwoko  Purwoko; Handayu  Ganitafuri

doi:10.3889/oamjms.2023.10147

Authors

Septian Adi Permana Department of Public Health, Faculty of Health Sciences, Jenderal Soedirman University, Purwokerto, Indonesia https://orcid.org/0000-0002-2535-0483
Adhrie Sugiarto Department of Anesthesiology and Intensive Therapy, Cipto Mangunkusumo Central Hospital, Jakarta, Indonesia
Sidharta Kusuma Manggala Department of Anesthesiology and Intensive Therapy, Cipto Mangunkusumo Central Hospital, Jakarta, Indonesia
Muhammad Husni Thamrin Department of Anesthesiology and Intensive Therapy, Dr. Moewardi Hospital Surakarta, Central Java, Indonesia
Purwoko Purwoko Department of Anesthesiology and Intensive Therapy, Dr. Moewardi Hospital Surakarta, Central Java, Indonesia
Handayu Ganitafuri Department of Anesthesiology and Intensive Therapy, Dr. Moewardi Hospital Surakarta, Central Java, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2023.10147

Keywords:

COVID-19, Tocilizumab, Acute respiratory distress syndrome, Intubation

Abstract

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has created severe medical and economic consequences worldwide since 2019. Tocilizumab is one of the therapies considered capable of improving the condition of patients with COVID-19. However, there is not much information about the best time to give tocilizumab.

METHODS: This was an analytical study with a retrospective cohort design, using the data of 125 patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with signs of acute respiratory distress syndrome in Dr. Moewardi Hospital, Surakarta, from March to August 2020. We analyzed various available clinical data to see which factors into clinical improvement with tocilizumab therapy.

RESULTS: Most patients showed clinical improvement after administration of tocilizumab. During the follow-up period, 21 patients died despite tocilizumab therapy. Significant risk factors associated with the need for intubation were heart rate, neutrophil, lymphocyte, pH, PaCO2, and PO2. The most influential variable on the need for intubation without being associated with other risk factors was PaO2 (p = 0.003, Confidence Intervals 95%).

CONCLUSIONS: Tocilizumab has a role in treating patients infected by SARS-CoV-2, preventing the need for intubation when given to patients in good saturation condition with oxygen supplementation without positive pressure (PaO2 >65mmHg; SpO2 >93%).

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