EAJAIC
Eurasian Journal of Anesthesiology and Intensive Care

The Eurasian Journal of Anesthesiology and Intensive Care (EAJAIC) is an independent-unbiased, peer-reviewed, "double-blind", and open-access journal of current national and international issues and reviews for original clinical and experimental research, interesting case reports, differential diagnoses, editorial opinions, letters to the editor, and educational papers in anesthesiology, algology, and intensive care medicine.

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eISSN: 3023-6738
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Original Article
Comparison of interleukin-6 receptor antagonist and pulse steroid therapy in critically ill patients with COVID-19: retrospective analysis
Abstract
Aims: Severe COVID-19 is characterized by acute respiratory distress syndrome accompanied by hypercytokinemia. In our study, we aimed to demonstrate the efficacy of the treatments such as interleukin-6 receptor antagonists and corticosteroids used in critically ill patients with COVID-19.
Methods: COVID-patients with cytokine storm treated in the intensive care unit between March 2020 and July 2021 were included in the study. Patients with increased neutrophil/lymphocyte ratio, lactate dehydrogenase, C-reactive protein, and ferritin and patients with oxygen saturations of 90% or lower, lymphopenia and fever were also considered to be in cytokine storm. Patients were divided into three groups: Tocilizumab Group, Steroid Group, Standard treatment Group.
Results: There was no statistically significant difference between the groups in terms of age and body mass index averages, gender ratios and concomitant diseases. The duration of stay in the intensive care unit and time on mechanical ventilation were found to be longer in the toculizimab group. There was no difference in mortality and the need for mechanical ventilation between the groups. On the other hand, ventilator-associated pneumonias were found to be higher in the pulse steroid group.
Conclusion: The close follow-up of the patients and early diagnosis of hypercytokinemia increase the success of the treatment, and accelerate to discharge from intensive care units. We think that it is important to select appropriate patients and pulse steroid is more suitable for use in cytokine storm because it is cheaper and more accessible.

Keywords : COVID-19 , corticosteroids, ARDS, interleukin-6, Tocilizumab

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1. World Health Organization. 2021. WHO coronavirus (COVID-19) dashboard. (Accessed November 2021). https://covid19.who.int/.
2. Fajgenbaum DC, June CH, Cytokine storm. N Engl J Med. 2020;383(23): 2255-2273. doi:10.1056/NEJMra2026131
3. McGonagle D, Sharif K, O’Regan A, Bridgewood C. The role of cytokines including interleukin-6 in COVID-19 induced pneumonia and macrophage activation syndrome-like disease. Autoimmun Rev. 2020;19(6):102537. doi: 10.1016/j.autrev.2020.102537
4. Opoka-Winiarska V, Grywalska E, Rolinski J. Could hemophagocytic lymphohistiocytosis be the core issue of severe COVID-19 cases? BMC Med. 2020;18(1):214. doi:10.1186/s12916-020-01682-y
5. Pedersen SF, Ho YC. SARS-CoV-2: a storm is raging. J Clin Invest. 2020; 130(5):2202-2205. doi:10.1172/JCI137647
6. Xu X, Han M, Li T, et al. Effective treatment of severe COVID-19 patients with tocilizumab.Proc Natl Acad Sci USA. 2020;117(20):10970-10975. doi: 10.1073/pnas.2005615117<strong> </strong>
7. Zhang W, Zhao Y, Zhang F, et al. The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): the perspectives of clinical immunologists from China. Clinical Immunology. 2020;214:108393. doi:10.1016/j.clim.2020.108393
8. Bastard P, Rosen LB, Zhang Q, et al. Autoantibodies against type I IFNs in patients with life-threatening COVID-19. Science. 2020;370(6515): eabd4585. doi:10.1126/science.abd4585
9. Zhang Q, Bastard P, Liu Z, et al. Inborn errors of type I IFN immunity in patients with life-threatening COVID-19. Science. 2020;370(6515): eabd4570. doi:10.1126/science.abd4570
10. Liu Y, Du X, Chen J, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect. 2020;81(1):e6-e12. doi:10.1016/j.jinf.2020.04.002
11. ang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients.Int Immunopharmacol. 2020;84: 106504. doi:10.1016/j.intimp.2020.106504
12. Boyiadzis M, Bishop MR, Abonour R, et al. The society for immunotherapy of cancer consensus statement on immunotherapy for the treatment of hematologic malignancies: multiple myeloma, lymphoma, and acute leukemia. J Immunother Cancer. 2016;4(1):90. doi:10.1186/s40425-016-0188-z
13. Herold T, Jurinovic V, Arnreich C, et al. Elevated levels of IL-6 and CRP predict the need for mechanical ventilation in COVID-19. J Allergy Clin Immunol. 2020;146(1):128-136.e4. doi:10.1016/j.jaci.2020.05.008
14. Laguna-Goya R, Utrero-Rico A, Talayero P, et al. IL-6-based mortality risk model for hospitalized patients with COVID-19. J Allergy Clin Immunol. 2020;146(4):799-807.e9. doi:10.1016/j.jaci.2020.07.009
15. Tleyjeh IM, Kashour Z, Damlaj M, et al. Efficacy and safety of tocilizumab in COVID-19 patients: a living systematic review and meta-analysis. Clin Microbiol Infect. 2021;27(2):215-227. doi:10.1016/j.cmi.2020.10.036
16. RECOVERY Collaborative Group, Horby P, Lim WS, et al. Dexamethasone in Hospitalized Patients with Covid-19.N Engl J Med. 2021;384(8):693-704. doi:10.1056/NEJMoa2021436
17. WHO rapid evidence appraisal for COVID-19 therapies (REACT) working group, Sterne JAC, Murthy S, et al. Association between administration of systemic corticosteroids and mortality among critically ill patients with COVID-19: a meta-analysis. JAMA. 2020;324(13):1330-1341. doi:10.1001/jama.2020.17023<strong> </strong>
18. World Health Organization. Corticosteroids for COVID-19: living guidance, 2 September 2020. World Health Organization.
19. Turkish Ministry of Health COVID-19 guideline: anticytokin antiinflammatory therapies coagulopathy treatment. 2 November 2020. Ankara.
20. Edalatifard M, Akhtari M, Salehi M, et al. Intravenous methylprednisolone pulse as a treatment for hospitalised severe COVID-19 patients: results from a randomised controlled clinical trial. Eur Respir J. 2020;56(6):2002808. doi:10.1183/13993003.02808-2020
21. Cusacovich I, Aparisi &Aacute;, Marcos M, et al. Corticosteroid pulses for hospitalized patients with COVID-19: effects on mortality. Mediators Inflamm. 2021;2021:6637227. doi:10.1155/2021/6637227.
22. National Institutes of Health. Coronavirus disease 2019 (COVID-19) treatment guidelines. https://covid19treatmentguidelines.nih.gov/ (Accessed on May 27, 2022).
23. Infectious diseases society of American Guidelines on the treatment and management of patients with COVID-19 https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/ (Accessed on February 21, 2022).
24. Aziz M, Haghbin H, Abu Sitta E, et al. Efficacy of tocilizumab in COVID-19: a systematic review and meta-analysis. J Med Virol. 2021;93(3):1620-1630. doi:10.1002/jmv.26509
25. Malgie J, Schoones JW, Pijls B.G. Decreased mortality in COVID-19 patients treated with Tocilizumab: a rapid systematic review and meta-analysis of observational studies. Clin Infect Dis. 2021;72(11):e742-e749. doi:10.1093/cid/ciaa1445
26. Gupta S, Wang W, Hayek SS, et al. Association between early treatment with tocilizumab and mortality among critically ill patients with COVID-19 JAMA Intern Med. 2021;181(1):41-51. doi:10.1001/jamainternmed.2020. 6252
27. Stuck AE, Minder CE, Frey FJ. Risk of infectious complications in patients taking glucocorticosteroids. Rev Infect Dis. 1989;11(6):954-963. doi:10. 1093/clinids/11.6.954
28. Cano EJ, Fonseca Fuentes X, Corsini Campioli C, et al. Impact of Corticosteroids in coronavirus disease 2019 outcomes: systematic review and meta-analysis.Chest. 2021;159(3):1019-1040. doi:10.1016/j.chest.2020. 10.054
29. Yılmaz B, Ergut Sezer B, G&uuml;nkaya M, Onar L&Ccedil;, Sivri F. Yoğun bakımda COVID-19 pn&ouml;monili hastalarda tosilizumab kullanımı: olgu serisi. J Turk Soc Intens Care. 2020;18:61-66. doi:10.4274/tybd.galenos.2020.19483
Article available in :
Volume 2, Issue 1, 2025
Page : 7-11
https://doi.org/10.51271/EAJAIC-0022
Article Information
Received : 15 Eyl 2024
Accepted : 16 Kas 2024
Published : 03 Şub 2025
Corresponding Author :

Münire Babayiğit: Department of Anesthesiology and Reanimation, Ankara Ataturk Sanatorium Training and Research Hospital, University of Health Sciences, Ankara, Turkiye

[email protected]
Citation : Koç F, Babayiğit M, Babayiğit MA, Menteş O, Fırat Göktaş E, Dereli N. Comparison of interleukin-6 receptor antagonist and pulse steroid therapy in critically ill patients with COVID-19: retrospective analysis. Eur J Anesthesiol Intens Care. 2025;2(1):7-11.

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