dc.creator | Dalekos G.N., Stefos A., Georgiadou S., Lygoura V., Michail A., Ntaios G., Samakidou A., Giannoulis G., Gabeta S., Vlychou M., Petinaki E., Leventogiannis K., Giamarellos-Bourboulis E.J., Gatselis N.K. | en |
dc.date.accessioned | 2023-01-31T07:49:23Z | |
dc.date.available | 2023-01-31T07:49:23Z | |
dc.date.issued | 2021 | |
dc.identifier | 10.1016/j.ejim.2021.03.026 | |
dc.identifier.issn | 09536205 | |
dc.identifier.uri | http://hdl.handle.net/11615/73017 | |
dc.description.abstract | Aims Infection by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) may lead to the development of severe respiratory failure. In hospitalized-patients, prompt interruption of the virus-driven inflammatory process by using combination treatments seems theoretically of outmost importance. Our aim was to investigate the hypothesis of multifaceted management of these patients. Methods A treatment algorithm based on ferritin was applied in 311 patients (67.2% males; median age 63-years; moderate disease, n=101; severe, n=210). Patients with ferritin <500ng/ml received anakinra 2-4mg/kg/day ± corticosteroids (Arm A, n=142) while those with ≥500ng/ml received anakinra 5-8mg/kg/day with corticosteroids and γ-globulins (Arm B, n=169). In case of no improvement a single dose of tocilizumab (8mg/kg; maximum 800mg) was administered with the potential of additional second and/or third pulses. Treatment endpoints were the rate of the development of respiratory failure necessitating intubation and the SARS-CoV-2-related mortality. The proposed algorithm was also validated in matched hospitalized-patients treated with standard-of-care during the same period. Results In overall, intubation and mortality rates were 5.8% and 5.1% (0% in moderate; 8.6% and 7.6% in severe). Low baseline pO2/FiO2 and older age were independent risk factors. Comparators had significantly higher intubation (HR=7.4; 95%CI: 4.1-13.4; p<0.001) and death rates (HR=4.5, 95%CI: 2.1-9.4, p<0.001). Significant adverse events were rare, including severe secondary infections in only 7/311 (2.3%). Conclusions Early administration of personalized combinations of immunomodulatory agents may be life-saving in hospitalized-patients with COVID-19. An immediate intervention (the sooner the better) could be helpful to avoid development of full-blown acute respiratory distress syndrome and improve survival. © 2021 | en |
dc.language.iso | en | en |
dc.source | European Journal of Internal Medicine | en |
dc.source.uri | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85103700786&doi=10.1016%2fj.ejim.2021.03.026&partnerID=40&md5=9c1031becf611698b3fe4bc80cf3d9dc | |
dc.subject | alanine aminotransferase | en |
dc.subject | anakinra | en |
dc.subject | antibiotic agent | en |
dc.subject | C reactive protein | en |
dc.subject | D dimer | en |
dc.subject | dexamethasone | en |
dc.subject | enoxaparin | en |
dc.subject | ferritin | en |
dc.subject | granulocyte colony stimulating factor | en |
dc.subject | hydrocortisone | en |
dc.subject | immunoglobulin | en |
dc.subject | lactate dehydrogenase | en |
dc.subject | methylprednisolone | en |
dc.subject | remdesivir | en |
dc.subject | tocilizumab | en |
dc.subject | interleukin 1 receptor blocking agent | en |
dc.subject | adult | en |
dc.subject | adult respiratory distress syndrome | en |
dc.subject | alanine aminotransferase level | en |
dc.subject | algorithm | en |
dc.subject | anasarca | en |
dc.subject | Article | en |
dc.subject | bacteremia | en |
dc.subject | bacterial pneumonia | en |
dc.subject | bloodstream infection | en |
dc.subject | breathing rate | en |
dc.subject | Candida | en |
dc.subject | catheter infection | en |
dc.subject | chronic obstructive lung disease | en |
dc.subject | combination drug therapy | en |
dc.subject | comorbidity | en |
dc.subject | computer assisted tomography | en |
dc.subject | controlled study | en |
dc.subject | coronary artery disease | en |
dc.subject | coronavirus disease 2019 | en |
dc.subject | COVID-19 testing | en |
dc.subject | diabetes mellitus | en |
dc.subject | disease duration | en |
dc.subject | disease severity | en |
dc.subject | drug half life | en |
dc.subject | drug megadose | en |
dc.subject | drug pulse therapy | en |
dc.subject | drug withdrawal | en |
dc.subject | female | en |
dc.subject | ferritin blood level | en |
dc.subject | follow up | en |
dc.subject | fraction of inspired oxygen | en |
dc.subject | heart failure | en |
dc.subject | hematoma | en |
dc.subject | hospital admission | en |
dc.subject | hospital infection | en |
dc.subject | hospital patient | en |
dc.subject | hospitalization | en |
dc.subject | human | en |
dc.subject | hypertension | en |
dc.subject | immunotherapy | en |
dc.subject | injection site reaction | en |
dc.subject | intubation | en |
dc.subject | Kolmogorov Smirnov test | en |
dc.subject | lactate dehydrogenase blood level | en |
dc.subject | leukocyte count | en |
dc.subject | lower respiratory tract infection | en |
dc.subject | lung embolism | en |
dc.subject | lung infiltrate | en |
dc.subject | lymphocyte count | en |
dc.subject | lymphocytopenia | en |
dc.subject | major clinical study | en |
dc.subject | male | en |
dc.subject | mesenteric vein thrombosis | en |
dc.subject | mortality rate | en |
dc.subject | nasopharyngeal swab | en |
dc.subject | neutropenia | en |
dc.subject | neutrophil count | en |
dc.subject | obesity | en |
dc.subject | observational study | en |
dc.subject | osteoporosis | en |
dc.subject | oxygen saturation | en |
dc.subject | oxygen tension | en |
dc.subject | oxygen therapy | en |
dc.subject | pathophysiology | en |
dc.subject | peripheral edema | en |
dc.subject | phase 3 clinical trial (topic) | en |
dc.subject | platelet count | en |
dc.subject | pneumonia | en |
dc.subject | prospective study | en |
dc.subject | pulse oximetry | en |
dc.subject | respiratory failure | en |
dc.subject | risk factor | en |
dc.subject | secondary infection | en |
dc.subject | single drug dose | en |
dc.subject | Stenotrophomonas maltophilia | en |
dc.subject | thorax radiography | en |
dc.subject | thrombocytopenia | en |
dc.subject | treatment contraindication | en |
dc.subject | treatment duration | en |
dc.subject | treatment outcome | en |
dc.subject | aged | en |
dc.subject | middle aged | en |
dc.subject | respiratory distress syndrome | en |
dc.subject | respiratory failure | en |
dc.subject | Aged | en |
dc.subject | COVID-19 | en |
dc.subject | Female | en |
dc.subject | Humans | en |
dc.subject | Interleukin 1 Receptor Antagonist Protein | en |
dc.subject | Male | en |
dc.subject | Middle Aged | en |
dc.subject | Respiratory Distress Syndrome | en |
dc.subject | Respiratory Insufficiency | en |
dc.subject | SARS-CoV-2 | en |
dc.subject | Treatment Outcome | en |
dc.subject | Elsevier B.V. | en |
dc.title | Lessons from pathophysiology: Use of individualized combination treatments with immune interventional agents to tackle severe respiratory failure in patients with COVID-19 | en |
dc.type | journalArticle | en |