CÁC YẾU TỐ NGUY CƠ CỦA THẤT BẠI ĐIỀU TRỊ VỚI TOCILIZUMAB SAU 48 GIỜ Ở BỆNH NHÂN COVID-19 MỨC ĐỘ TRUNG BÌNH - NẶNG

Abstract

Introduction: The cytokine storm, characterized by an increase in IL-6, is a major factor causing multi-organ damage and acute respiratory distress syndrome (ARDS) in severe COVID-19 patients. Tocilizumab (TCZ), an IL-6 receptor inhibitor, is used to control this inflammatory response. However, the treatment effectiveness may vary, and identifying early risk factors for treatment failure is critical to improving patient care. Methods: A retrospective study was conducted on 44 COVID-19 patients treated with TCZ at Cho Ray Hospital from July 2021 to June 2022. Clinical and laboratory indicators such as CRP, IL-6, and D-dimer were monitored before and at 12 hours, 24 hours, and 48 hours after TCZ administration. Multivariate Cox regression analysis was used to identify predictors of treatment failure. Results: Among the 44 patients (mean age 56 ± 16), 12 patients (27.3%) experienced treatment failure after 48 hours, and up to 10 patients (83.3% of the failure cases) subsequently died. In contrast, only 5 patients in the 32 successful cases died. Within 48 hours after TCZ administration, CRP levels significantly increased in the failure group (61 ± 25 mg/L) compared to the success group (14 ± 8 mg/L) (p=0.009), while IL-6 also showed a marked increase in the failure group (476 ± 90 pg/mL vs 122 ± 40 pg/mL; p<0,047). A high APACHE II score was the promising predictor of treatment failure before TCZ administration, suggesting that it should be reevaluated in better-designed studies. Conclusion: Increased CRP and IL-6 levels within 48 hours after TCZ administration are important early risk factors for predicting treatment failure in moderate-to-severe COVID-19 patients. These findings emphasize the need for early intervention and alternative strategies for non-responding patients to improve treatment outcomes.