• Lucia Taramasso, Laura Magnasco, Federica Portunato, Federica Briano, Antonio Vena, Daniele R Giacobbe, Chiara Dentone, Chiara Robba, Lorenzo Ball, Maurizio Loconte, Nicolò Patroniti, Paolo Frisoni, Raffaele D'Angelo, Silvia Dettori, Malgorzata Mikulska, Paolo Pelosi, and Matteo Bassetti.
• Infectious Diseases Unit, Department of Internal Medicine, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy. Electronic address: taramasso.lucia@gmail.com.
• Eur. J. Intern. Med. 2021 Dec 1; 94: 394439-44.

ObjectivesThe hypothesis of this study is that tocilizumab should affect common signs of infection due to its immunosuppressive properties. Primary aim of the study was to investigate whether the administration of tocilizumab to critically ill patients with COVID-19, led to a different clinical presentation of infectious complications compared to patients who did not receive tocilizumab. Secondary aim was investigating differences in laboratory parameters between groups.MethodsSingle-centre retrospective study, enrolling COVID-19 patients who developed a microbiologically confirmed infectious complication [ventilator associated pneumonia or bloodstream infection] after intensive care unit [ICU] admission and either treated with tocilizumab or not [controls].ResultsA total of 58 patients were included, 25 treated with tocilizumab and 33 controls. Median time from tocilizumab administration to infection onset was 10 days [range 2-26]. Patients were 78% male, with median age 65 years [range 45-79]. At first clinical presentation of the infectious event, the frequency of hypotension [11/25, 44% vs. 11/33, 33%], fever [8/25, 32% vs. 10/33, 30%] or hypothermia [0/25,0%, vs. 2/33, 6%], and oxygen desaturation [6/25, 28% vs 4/33, 12%], as well as the frequency of SOFA score increase of ≥ 2 points [4/25, 16%,vs. 4/33, 12%] was similar in tocilizumab treated patients and controls [p>0.1 for all comparisons]. Among laboratory parameters, C-Reactive Protein elevation was reduced in tocilizumab treated patients compared to controls [8/25, 32% vs. 22/33, 67%, p=0.009].ConclusionThe clinical features of infectious complications in critically ill patients with COVID-19 admitted to ICU were not affected by tocilizumab.Copyright © 2021. Published by Elsevier B.V.

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