C-reactive protein cut-off for early tocilizumab and dexamethasone prescription in hospitalized patients with COVID-19
Ana M. Camon, Rodrigo Alonso, Francisco Javier Teigell Muñoz, Celia Cardozo, Javier Bernal-Maurandi, Laia Albiach, Daiana Agüero, María Ángeles Marcos, Juan Ambrosioni, Marta Bodro, Mariana Chumbita, Lorena de la Mora, Nicole García-Pouton, Gerard Dueñas, Marta Hernández‐Meneses, Alexy Inciarte, Genoveva Cuesta, Fernanda Meira, Laura Morata, Pedro Puerta‐Alcalde, Verónica Rico, Sabina Herrera, Montse Tuset, Pedro Castro, Sergio Prieto‐González, Alex Almuedo-Riera, José Muñóz, Josep Mensa, Gemma Sanjuan, José M. Nicolás, Ana del Rı́o, Jordi Vilà, Felipe García, José Antonio Martínez, Carolina García‐Vidal, Àlex Soriano, J. L. Blanco, Josep Mallolas, Estebán Martínez, Miguel J. Martínez, José M. Miró, Antonio Moreno, M. Larroya Sola, Ainoa Ugarte, Ana Gonzalez‐Cordón, Montse Laguno, Lorna Leal, John Rojas, Berta Torres, all the staff members, Sara Fernández, Adrián Téllez, Fernando Fuentes, Mireia Urrea Ayala, Esther Sancho, D. Campubri, M. T. de Alba, M. Fernandez, Esther Jaén Ferrer, B. Grau, H. Marti, M. Muelas, María‐Jesús Pinazo, Natàlia Rodríguez, M. Roldan, Carme Subirà, I. Vera, Neely Williams, Alex Almuedo-Riera, all the staff members, Anna Aldea, Miguel Camafort, Jorge Calvo, Abelardo Capdevila, Francesc Cardellach, Irene Carbonell, Emmanuel Coloma, Alberto Foncillas, Ramón Estruch, M. Feliu, Joaquim Fernández‐Solà, Irene Fuertes, Cristina Gabara, Ignacio Grafiá, A. Ladino, R. López-Alfaro, Alfonso López‐Soto, Irene Macaya, Ferrán Masanés, Arthur J. Matas, Mireia Navarro, J. Marco- Hernández, Lucas San Miguel, José C. Milisenda, Pedro Moreno, José Naval-Álvarez, David Nicolás, H.K. Oberoi, Joan Padrosa, Martina Pellicé
Abstract
Dexamethasone and tocilizumab have been associated with reduction in mortality, however, the beneficial effect is not for all patients and the impact on viral replication is not well defined. We hypostatized that C-reactive protein (CRP) could help in the identification of patients requiring anti-inflammatory therapy. Patients admitted for > 48 h in our hospital for a confirmed or suspected infection by SARS-CoV-2 from February 2020 to February 2021 were retrospectively evaluated. The primary outcome was mortality at 30 days. Demographics and the most relevant variables related with the outcome were included. CRP was stratified by percentiles. Univariate and multivariate analysis were performed. A total of 3218 patients were included with a median (IQR) age of 66 (74-78) years and 58.9% were males. The rate of intensive care unit admission was 24.4% and the 30-day mortality rate was 11.8%. Within the first 5 days from admission, 1018 (31.7%) patients received dexamethasone and 549 tocilizumab (17.1%). The crude analysis showed a mortality reduction in patients receiving dexamethasone when CRP was > 13.75 mg/dL and > 3.5 mg/dL for those receiving tocilizumab. Multivariate analysis identified the interaction of CRP > 13.75 mg/dL with dexamethasone (OR 0.57; CI 95% 0.37-0.89, P = 0014) and CRP > 3.5 mg/dL with tocilizumab (0.65; CI95%:0.44-0.95, P = 0.029) as independent predictors of mortality. Our results suggest that dexamethasone and tocilizumab are associated with a reduction in mortality when prescribed to patients with a certain inflammatory activity assessed by C-reactive protein.