Salvador Pérez-Galera

Instituto de Biomedicina de Sevilla

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Jesús Rodríguez‐Baño

Hospital Universitario Virgen Macarena

Belén Gutiérrez‐Gutiérrez

Instituto de Biomedicina de Sevilla

José Antonio Girón-Ortega

Hospital Universitario Virgen Macarena

Patricia Muñóz

Hospital General Universitario Gregorio Marañón

Isabel Morales

Hospital Universitario Virgen Macarena

Beatriz Sobrino Diaz

Hospital Regional Universitario de Málaga

Juan Diego Ruiz Mesa

Hospital Regional Universitario de Málaga

Beatriz Díaz‐Pollán

Hospital Universitario La Paz

Pierluigi Viale

University of Bologna

Lucía Valiente de Santis

Hospital Regional Universitario de Málaga

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Instituto de Salud Carlos III

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Centro de Investigación Biomédica en Red

Hospital Universitario Virgen Macarena

Universidad de Sevilla

Instituto de Biomedicina de Sevilla

Red Espanola de Investigacion en Patologia Infecciosa

Hospital General Universitario Gregorio Marañón

Universitat de Barcelona

Hospital Universitario La Paz

Bellvitge University Hospital

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

Clinical Microbiology and Infection (2020)

Jesús Rodríguez‐Baño Jerónimo Pachón Jordi Carratalà Pablo Ryan Inmaculada Jarrín

ObjectivesThe 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.MethodsA 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).ResultsIn 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).ConclusionsTocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situation.

Tocilizumab

2019-20 coronavirus outbreak

10.1016/j.cmi.2020.08.010

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Attributable mortality of infections caused by carbapenem-resistant Enterobacterales: results from a prospective, multinational case-control-control matched cohorts study (EURECA)

Clinical Microbiology and Infection (2024)

María Paniagua‐García José María Bravo-Ferrer Salvador Pérez-Galera Tomislav Kostyanev Marlieke E.A. de Kraker

Abstract

Objectives

To assess the mortality attributable to infections caused by carbapenem-resistant Enterobacterales (CRE) and to investigate the effect of clinical management on differences in observed outcomes in a multinational matched cohort study.

Methods

A prospective matched-cohorts study (NCT02709408) was performed in 50 European hospitals from March 2016 to November 2018. The main outcome was 30-day mortality with an active post-discharge follow-up when applied. The CRE cohort included patients with complicated urinary tract infections, complicated intra-abdominal infections, pneumonia, or bacteraemia from other sources because of CRE. Two control cohorts were selected: patients with infection caused by carbapenem-susceptible Enterobacterales (CSE) and patients without infection. Matching criteria included type of infection for the CSE group, hospital ward of CRE detection, and duration of hospital admission up to CRE detection. Multivariable and stratified Cox regression was applied.

Results

The cohorts included 235 patients with CRE infection, 235 patients with CSE infection, and 705 non-infected patients. The 30-day mortality (95% CI) was 23.8% (18.8–29.6), 10.6% (7.2–15.2), and 8.4% (6.5–10.6), respectively. The difference in 30-day mortality rates between patients with CRE infection when compared with patients with CSE infection was 13.2% (95% CI, 6.3–20.0), (HR, 2.57; 95% CI, 1.55–4.26; p < 0.001), and 15.4% (95% CI, 10.5–20.2) when compared with non-infected patients (HR, 3.85; 95% CI, 2.57–5.77; p < 0.001). The population attributable fraction for 30-day mortality for CRE vs. CSE was 19.28%, and for CRE vs. non-infected patients was 9.61%. After adjustment for baseline variables, the HRs for mortality were 1.87 (95% CI, 0.99–3.50; p 0.06) and 3.65 (95% CI, 2.29–5.82; p < 0.001), respectively. However, when treatment-related time-dependent variables were added, the HR of CRE vs. CSE reduced to 1.44 (95% CI, 0.78–2.67; p 0.24).

Discussion

CRE infections are associated with significant attributable mortality and increased adjusted hazard of mortality when compared with CSE infections or patients without infection. Underlying patient characteristics and a delay in appropriate treatment play an important role in the CRE mortality.

10.1016/j.cmi.2023.11.008

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Citations (16)