Volume 10 Issue 4 - 2020
Can Tocilizumab Reduce the Need of Invasive Mechanical Ventilator in COVID 19 Induced Cytokine Storm?
Anand Agrawal1*, Kamaljeet Singh2, Rishi Rana3 and Shikha Goel4
1Professor and Head, Department of Respiratory Medicine, BPSGMC(W) KK, Sonepat, Haryana, India
2Assistant Professor, Department of Respiratory Medicine, BPSGMC(W) KK, Sonepat, Haryana, India
3Specialist Consultant, Department of Respiratory Medicine, BPSGMC(W) KK, Sonepat, Haryana, India
4Tutor, Department of Pathology, NC Medical College and Hospital, Panipat, India
*Corresponding Author: Anand Agrawal, Professor and Head, Department of Respiratory Medicine, BPSGMC (W) KK, Sonepat, Haryana, India.
Received: February 20, 2021; Published: March 09, 2021

SARS-CoV-2 may cause fatal clinico-pathological changes after replicating in the lower respiratory tract which may lead to wide spectrum of the disease severity including pneumonia, pulmonary edema/ARDS. While ARDS develops in 42% of patients presenting with COVID‐19 pneumonia and 61 - 81% of those requires intensive care. According to researcher the intensive care unit and hospital mortality from typical ARDS is 35.3% to 40.0%, however for COVID‐19 ARDS, mortality ranged between 26% to 61.5%, unfortunately if admitted in ICU and received mechanical ventilation, the mortality may exponentially increased to 65.7% to 94%, perhaps due to aggressive inflammatory responses [1]. Although COVID-19 pathogenesis is still not very clear to the scientific community, some patients with a severe disease have laboratory evidence of a sharp increase in large number of pro-inflammatory cytokines, including IL-6, which is secreted by various type of leukocytes, plays a decisive role in the inflammatory response. IL-6 can bind its mIL-6R at low concentration or, sIL-6R at higher concentration, creating the activated complex with gp130protein, facilitate signaling by Janus kinases (JAK) and Ras/mitogenactivated protein kinase (MAPK)/NF-B-IL-6 [2]. Though elevated levels of IL-6 not only associated with cytokine release syndrome but also attributed with a hypercoagulable state in humans, proposed to be associated with high risk of death in COVID 19 [3]. According to literature the optimum critical point of IL-6 was determined as 24.3 pg/ml in severe COVID-19 group with sensitivity and specificity of 73.3 and 89.3%, though along with D-Dimer, it reached to 93.3%, and 96.4% respectively [4].


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  3. Nannoni S., et al. “Stroke in COVID-19: A systematic review and meta-analysis”. International Journal of Stroke 11 (2020): 1747493020972922.
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  7. Moreno-Pérez O., et al. “Experience with tocilizumab in severe COVID-19 pneumonia after 80 days of follow-up: A retrospective cohort study”. Journal of Autoimmunity 114 (2020): 102523.
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  11. Boregowda U., et al. “Addition of Tocilizumab to the Standard of Care Reduces Mortality in Severe COVID-19: A Systematic Review and Meta-Analysis”. Frontiers of Medicine 7 (2020): 586221.
  12. Colaneri M., et al. “Tocilizumab for Treatment of Severe COVID-19 Patients: Preliminary Results from SMAtteo COvid19 REgistry (SMACORE)”. Microorganisms5 (2020): 695.
Citation: Anand Agrawal., et al. “Can Tocilizumab Reduce the Need of Invasive Mechanical Ventilator in COVID 19 Induced Cytokine Storm?”. EC Pulmonology and Respiratory Medicine 10.4 (2021): 01-03.

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