Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Complicaciones durante la estancia hospitalaria en los pacientes con evento cerebrovascular en el departamento de clínica del Hospital Vicente Corral Moscoso de la ciudad de Cuenca en los años 2005 al 2009

Estudio descriptivo, cuantitativo, retrospectivo y longitudinal. La investigación se realizó en base a las historias clínicas de los pacientes hospitalizados con evento cerebro vascular, en el departamento de clínica del hospital Vicente Corral Moscoso, ubicado en la Av. los Arupos y Av. 12 de Abril, del cantón Cuenca, provincia del Azuay, de la república del Ecuador. Para el levantamiento de los datos se utilizó el formulario previamente elaborado y validado, fue llenado por las personas participantes de la investigación; de acuerdo a la historia clínica de cada paciente. Resultados: El 79.74% de los pacientes con evento cerebro vascular que fueron hospitalizados en el HVCM son pacientes mayores de 56 años. Las complicaciones se presentaron con mayor frecuencia en las edades comprendidas entre 66-75 años con un 26.09%.Con respecto al sexo, 77 fueron mujeres y 76 fueron hombres, las complicaciones se presentaron más en las mujeres con un 52.17%.. La principal comorbilidad fue la HTA con un 78.43%. La principal etiología de ingreso fue el ECV hemorrágico con el 56.21%. Las principales complicaciones fueron urológicas con un 27.83% y las metabólicas también con el 27.83 %. De las urológicas, la principal fue las infecciones de vias urinarias con un 75%. Las alteraciones hidroelectroliticas fueron las principales complicaciones metabólicas con un 71.88%. En secuencia las complicaciones respiratorias se presentaron en el 21.74% de los pacientes. Otras complicaciones que se presentaron en menor porcentaje fueron: complicaciones digestivas, neurológicas, psiquiátricas, dermatológicas, hematológicas, dolor osteomuscular, deterioro progresivo del paciente, muerte del paciente.auObjective: To establish the complications during hospital stay in patients with stroke in the Department of Clinical Vicente Corral Moscoso Hospital in Cuenca in 2005 and 2009. Methods and Materials: This descriptive study was retrospective, longitudinal study. The research was conducted based on the medical records of hospitalized patients with stroke in the department of clinical Vicente Corral Moscoso Hospital, located at Av and Av the Arupos April 12, the Canton Cuenca province Azuay, the republic of Ecuador. For the survey data was used previously developed and validated form was completed by the participants of the investigation according to medical records of each patient. Results: 79.74% of patients with stroke who were hospitalized in the HVCM are patients over 56 years. Complications occurred more frequently in those aged 66-75 years with 26.09%. With regard to sex, 77 were female and 76 were men, there were more complications in women with a 52.17% .. The main comorbidity was HT with 78.43%. The main cause of admission was hemorrhagic CVD with 56.21%. The urological complications were 27.83% with metabolic and also with 27.83%. Of urological were the main urinary tract infections with 75%. The electrolyte disturbances were the main metabolic complications with 71.88%. In sequence respiratory complications occurred in 21.74% of patients. Other complications that occurred in a lower percentage were, digestive complications, neurological, psychiatric, dermatological, hematological, musculoskeletal pain, progressive deterioration of the patient's death. KEYWORDS: STROKE, COMPLICATIONS, HOSPITALIZATION, VICENTE CORRAL MOSCOSO HOSPITAL.MédicaCuenc