• Manuel Rubio-Rivas, José M Mora-Luján, Abelardo Montero, Josefa Andrea Aguilar García, Manuel Méndez Bailón, Ana Fernández Cruz, Isabel Oriol, Francisco-Javier Teigell-Muñoz, Beatriz Dendariena Borque, Andrés De la Peña Fernández, Raquel Fernández González, Ricardo Gil Sánchez, Javier Fernández Fernández, Marta Catalán, Begoña Cortés-Rodríguez, Mella PérezCarmenCDepartment of Internal Medicine, Ferrol Clinical University Hospital, El Ferrol, La Coruña, Spain., Lorena Montero Rivas, Rebeca Suárez Fuentetaja, Jara Eloísa Ternero Vega, Javier Ena, Anabel Martin-Urda Díez-Canseco, Cristina Pérez García, José F Varona, José Manuel Casas-Rojo, Jesús Millán Núñez-Cortés, and SEMI-COVID-19 Network.
• Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, Barcelona, Spain. mrubio@bellvitgehospital.cat.
• J Gen Intern Med. 2022 Jan 1; 37 (1): 168175168-175.

BackgroundThe inflammatory cascade is the main cause of death in COVID-19 patients. Corticosteroids (CS) and tocilizumab (TCZ) are available to treat this escalation but which patients to administer it remains undefined.ObjectiveWe aimed to evaluate the efficacy of immunosuppressive/anti-inflammatory therapy in COVID-19, based on the degree of inflammation.DesignA retrospective cohort study with data on patients collected and followed up from March 1st, 2020, to May 1st, 2021, from the nationwide Spanish SEMI-COVID-19 Registry. Patients under treatment with CS vs. those under CS plus TCZ were compared. Effectiveness was explored in 3 risk categories (low, intermediate, high) based on lymphocyte count, C-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, and D-dimer values.PatientsA total of 21,962 patients were included in the Registry by May 2021. Of these, 5940 met the inclusion criteria for the present study (5332 were treated with CS and 608 with CS plus TCZ).Main MeasuresThe primary outcome of the study was in-hospital mortality. Secondary outcomes were the composite variable of in-hospital mortality, requirement for high-flow nasal cannula (HFNC), non-invasive mechanical ventilation (NIMV), invasive mechanical ventilation (IMV), or intensive care unit (ICU) admission.Key ResultsA total of 5940 met the inclusion criteria for the present study (5332 were treated with CS and 608 with CS plus TCZ). No significant differences were observed in either the low/intermediate-risk category (1.5% vs. 7.4%, p=0.175) or the high-risk category (23.1% vs. 20%, p=0.223) after propensity score matching. A statistically significant lower mortality was observed in the very high-risk category (31.9% vs. 23.9%, p=0.049).ConclusionsThe prescription of CS alone or in combination with TCZ should be based on the degrees of inflammation and reserve the CS plus TCZ combination for patients at high and especially very high risk.© 2021. Society of General Internal Medicine.

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