Effect of Tocilizumab in Terms of Hospital Stay and Mortality Pattern Among Patients with Severe versus Critically-Ill Coronavirus Disease 2019 Patients: A Comparative Analytic Study

Abstract

Background and Objectives: Most patients with mild and moderate COVID-19 infection recover with 
standard care therapy. Mortality in patients with severe illness and those critically ill is high. Tocilizumab acts 
by blocking interleukin-6 receptors and shows promising results in severe disease. Aim of this study was to 
assess the effect of Tocilizumab in severe and critically ill COVID-19 patients in terms hospital stay and 
reducing the risk of death. 
Methods: In this comparative analytical, single-center study undertaken in DHQ university teaching 
hospital Gujranwala, forty-four patients were enrolled after an informed consent through non-probability 
consecutive sampling. The patients were categorized based on oxygen requirement as severe (oxygen 
requirement 10 L/min) and critically ill patients (oxygen requirement 15 L/min). All patients were treated 
with injection Tocilizumab (8mg per kg body weight) using criteria based on oxygen requirement (10L/min 
or more) and increased levels of any two of the laboratory investigations including CRP. D-Dimers, serum 
ferritin and LDH. Sociodemographic and clinical profile were collected using a semi-structured proforma. 
Outcome of interest was hospital stay and mortality. Comparison of effect of Tocilizumab was analyzed in 
regards to age, sex, laboratory investigations and stated outcome using Pearson's Chi-squared test. P-value of 
<0.05 was considered statistically significant. Data were analyzed using SPSS version 24.0.
Results: Of 44 COVID-19 patients, 26 (59.1%) had severe disease and 18 (40.9%) were critically ill. We did 
not observe any statistical difference between these two categories as regards age, sex, hospital stay or 
presence of co-morbid conditions. However, there were 17 (94%) deaths observed among critically ill patients. 
This mortality difference was found statistically significant (p<0.001).

Conclusion: Tocillizumab has shown significant effect to reduce mortality and minimizing hospital stay 
amongst COVID-19 patients with severe disease only with minimal effect in critically ill patients. Tocilizumab 
may be introduced early in treatment plan for severe COVID-19 patients. 

Keywords: COVID-19, Pandemic, Severe COVID-19 disease, critically ill, Mortality, Survival, Tocilizumab, 
Hospital stay,